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HealthyBlue - You Buy Your Own Health Insurance - Frequently Asked Questions

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HealthyBlue General Information

How does the HealthyBlue plan work?

Answer: HealthyBlue offers you financial rewards for being proactive about your health and knowing your health status. See the HealthyBlue comparison chart to view the various plans we offer.

How is HealthyBlue different from other plans?

Answer: HealthyBlue takes a different approach to your health care by rewarding you for better health by:

  • Removing obstacles to preventive screenings and primary care services by offering those services for little to no cost
  • Encouraging you to use our health assessment to help you understand and improve your health status

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Health Assessment

How do I complete the Health Assessment?

Answer: You can access the online health assessment through My Account, CareFirst’s secure member site.

Who can see my Health Assessment?

Answer: You are the only person who can access your health assessment online. If you choose to share your health assessment results with your PCP (a required step to earn your Blue Reward), we may share the data with your selected PCP.

We also recommend that you take a copy of your Health and Wellness Evaluation Form to your doctor visit so you can discuss the results.

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Blue Rewards General Information

What is Blue Rewards?

Answer: Blue Rewards is a new program that offers you incentives for taking an active role in getting healthy and staying healthy.

How do I earn my Blue Reward?

Answer: Complete all four steps to earn your Blue Reward!

  1. Select a primary care provider (PCP) who participates in our Patient-Centered Medical Home (PCMH) program— a program that provides your doctor with a more complete view of your health needs (ages 2+)
  2. Agree to receive wellness-related communications electronically (ages 18+)
  3. Complete an online health assessment (ages 18+)
  4. Visit your selected PCMH PCP and complete your Health and Wellness Evaluation Form (ages 2+)

Keep in mind you have 120 days from your effective date to finish the reward process.

How much can I earn?

Answer: Adults can earn $150 or up to $400 for a family that can be applied toward your premium payment, annual deductible or out-of-pocket costs like copays or coinsurance.

How long do I have to earn a reward?

Answer: You have 120 days from your plan’s effective date to complete the steps necessary to earn your reward.

When can I start earning a Blue Reward?

Answer: As soon as you pay your initial premium payment, you will be eligible to begin your Blue Reward steps.

Am I eligible for this reward if I sign-up on a state/local Exchange?

Answer: Yes! As long as you choose a plan from CareFirst it does not matter if you enroll on a State Exchange or directly through CareFirst.

If I receive a subsidy, am I eligible for a Blue Reward?

Answer: Yes! As long as you choose a plan from CareFirst it does not matter if you receive a subsidy - you are still eligible to earn your Blue Reward.

How long do I have to use my reward?

Answer: You must use your reward money by December 31, as it cannot carryover to another benefit year. The incentive card funds must be used for expenses that are incurred within your benefit period.

You will have a 90-day grace period at the end of your benefit period to submit expenses that were incurred within the benefit period. This means if you have any expenses that occurred on or before December 31, you can submit reimbursements until March 31 of the following year by logging into My Account. However, if you terminate your coverage, you have only until the end of the benefit period to submit expenses.

Does each member of a family have to complete all steps before the Blue Reward is earned?

Answer: No, as soon as one member of your family completes the required steps the policyholder will receive the incentive card. Each time a new member of the family completes his/her steps, their reward amount will be added to the policyholder’s card.

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Patient-Centered Medical Home (PCMH)

Explain the process to select a PCMH primary care provider (PCP).

Answer:

  • Log in or sign-up for My Account
  • Click on Blue Rewards under Quick Links
  • Click Start under Select a PCMH PCP and follow the screen prompts

What is a PCMH PCP and how does selecting one benefit me?

Answer: When you choose a PCMH provider, the focus is on improving your overall health and preventing health problems before they begin. A PCMH provider coordinates your health care needs and works with a team, when needed, to help you receive quality care in the right setting and at the right time.

Why should I select a PCMH provider?

Answer: The Blue Rewards program emphasizes high-quality and high-value health care. PCPs who participate in the PCMH program are committed to cost-savings and care quality for our members.

PCMH PCPs can help you take an active role in improving or maintaining your health through coordinated care and access to the tools and resources to design custom treatment plans, directing you to the proper care centers and closely monitoring your health conditions with the help of a large network of CareFirst nurses.

How do I find a PCMH PCP?

Answer: To locate a PCMH PCP, use our Find a Provider search tool. When you search for a PCMH PCP, you can filter to show only those providers who participate in the PCMH program. These providers will have the PCMH logo in their listings.

PCMH logo

Why isn’t my doctor a part of PCMH?

Answer: Provider participation in PCMH is voluntary. All providers in the CareFirst network must meet stringent credentialing requirements that are separate from the PCMH and Blue Rewards programs. A provider's lack of participation in PCMH should not suggest he/she does not provide quality health services.

Your PCP can enroll in the PCMH program and CareFirst would be happy to reach out to your provider to explain and invite them into the program. Please contact Member Service at the telephone number on the back of your ID card. Provide Member Service with the provider's name and address (if available) and we will reach out to the provider.

I’m in a PPO product; do I still need to select a PCP?

Answer: You are not required to select a PCP as part of your PPO or Advantage product upon enrollment; however, in order to earn your Blue Reward the selection of a PCMH PCP is required.

If you are outside of the CareFirst service area (MD, D.C., or Northern VA), you should select a provider in the BlueCard® PPO network from any of the following specialties: General Practice, Family Practice, Internal Medicine, Pediatrics or Geriatrics.

Can I get an exception (override) for selecting a PCMH PCP?

Answer: Unfortunately, there aren't any exceptions. In order to earn your Blue Reward, you must select a provider who participates in the PCMH program. You have the option to not participate in the Blue Rewards program if you do not wish to change providers.

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Health and Wellness Evaluation Form

Where can I get a copy of the Health and Wellness Evaluation Form to give to my doctor?

Answer: Health and Wellness Evaluation Form

Please be sure to take a copy of this form to your primary care provider (PCP) when you go for your Health and Wellness Evaluation visit.

Do I still need to see my doctor if I've completed these screenings and health measurements?

Answer: If you have recently completed the items required on the Health and Wellness Evaluation, you may not need to see your doctor again. Be sure to contact your doctor’s office because you will still need your doctor to sign the completed Health and Wellness Evaluation Form.

How do I send in the Health and Wellness Evaluation Form?

Answer: For the quickest processing, you can submit your results through My Account. Other ways to submit the form to CareFirst are listed on the back of the Health and Wellness Evaluation Form.

How will I know when the Health and Wellness Evaluation Form is received and when my Reward is available?

Answer: You can check the status of your reward by logging in to My Account or calling the member service number on your ID card.

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