HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

Administration of Your PlanPersonal & Enrollment ChangesIf you change your name, address or phonenumber, please contact Member Services andwe’ll update our records or advise you of anyforms you need to submit. Remember, we needyour correct address to keep you informed aboutcritical program information including policies,procedures and benefit changes.If you have group coverage and wish to enrollor disenroll a dependent (including newborns)or change your marital status, you must notifyyour employer within the timeframe specified inyour Evidence of Coverage/Agreement.Individual contract members may fill out aMembership Change Request form found onwww.carefirst.com make enrollment changes.Filing a Claim for ReimbursementTypically, when you see a non-participating provider,you’ll be responsible for filing your own claims.All CareFirst BlueChoice providers, andCareFirst PPO providers based in Maryland, arerequired to submit claims. All you have to do ispay any necessary copayment and/or deductibleat the time of the visit. If you need to submit aclaim for services rendered by a provider whodoesn’t participate in the CareFirst BlueChoice orCareFirst PPO network (such as emergency carereceived outside the Service Area), you may contactMember Services for a CareFirst BlueChoiceHealth Benefits Claim Form or print one from ourwebsite at www.carefirst.com.Be sure to attach a complete itemized bill preparedby the provider of service that includes the chargesfor each service along with the medical conditionfor which the treatment was performed. Submit thecompleted claim form and attachments to:Mail AdministratorP.O. Box 14114Lexington, KY 40512-4114Provider ReimbursementCareFirst BlueChoice providers are paid on a feefor-servicebasis meaning they receive paymentsaccording to a fee schedule for covered servicesthey perform. CareFirst PPO Network providersare paid the Allowed Benefit for services rendered.You may contact Member Services to obtainadditional information about provider paymentarrangements.Other insuranceWhen you or your dependents have additionalcoverage under another health plan or insuranceprogram (for example, a plan through yourspouse’s employer or Medicare) coordinationof benefits (COB) may apply. COB eliminatesduplicate payments for the same expense and playsan important role in controlling the price you payfor your health care coverage.While it’s important that you receive the healthbenefits you’re eligible for, it’s also importantthat payments are properly coordinated so thatone health insurance carrier does not exceed itspayment responsibility for your bill. The combinedpayment by CareFirst BlueChoice and the otherplan should not be more than the total amount ofthe bill.We update our COB information periodically,so make sure we have your most currentinformation or if your other insurance changed.When our records are up-to-date we’re able to payyour claims as quickly and accurately as possible.Even if you don’t have other insurance, it’simportant you provide that information to us sowe may keep your records current. To supply thisinformation, you may call our COB departmentat (866) 285-2611, or download a COB formin the “Forms” section of our website at www.carefirst.com. Rules to determine how benefitsare coordinated are outlined in your Evidence ofCoverage/Agreement.All claims must be filed within the time limit specifiedin your Evidence of Coverage/Agreement.HealthyBlue Member Handbook25