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Personal Comprehensive Frequently Asked Questions

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Enrollment

How can I cover my newborn from birth?

Answer: Your newborn child is automatically covered for the first 31 days from birth. You must notify CareFirst to continue coverage beyond the first 31 days if additional premium is required.

How do I obtain coverage for my newly adopted child?

Answer: Your adopted child is automatically covered for the first 31 days from the date of the adoption. You must notify CareFirst to continue coverage beyond the first 31 days if additional premium is required.

How do I add or delete coverage for family members?

Answer: Generally, to add family members to your coverage you must submit a medically underwritten application to CareFirst. Changes are effective on the first of the month following acceptance of the application by CareFirst. A newborn or adopted child is not subject to medical underwriting if added to your coverage within 31 days from the date of birth or date of adoption.

To delete family members, the policyholder must notify CareFirst except in the case of the policyholder's death.

Can I cover a dependent who lives out-of-state or my child living away at school?

Answer: You should contact the local Blue Cross and Blue Shield plan that services that area to cover a dependent who lives out-of-state or is away at school.

How often can I change benefit plans?

Answer: You may change your benefit plan by submitting a medically underwritten application to CareFirst if you are applying for a lower deductible. If you are applying for a higher deductible, you need to submit a change form which can be obtained through Member Services.

How long can my children remain covered?

Answer: Your child can remain covered up to age 19, or 25 if a full-time student, or until they marry.

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General Information

What happens to my coverage if I move out of the area?

Answer: Like all Blue Cross and Blue Shield licensees, CareFirst participates in a program called "BlueCard® ."
The BlueCard® program has a network of participating providers. These providers accept our payment (after the member's coinsurance and deductible) as payment in full. With BlueCard®, if you obtain services through a preferred provider, you receive benefits at the in-network level. If you choose not to see a BlueCard® preferred provider, benefits will be given at the out-of-network level.
Call BlueCard® a 1-800-810-BLUE (2583) to obtain names of participating preferred providers in the area. This number is printed on the back of your member ID card.

What happens to my coverage if I quit my job or I'm laid off or fired?

Answer: There is no change to your coverage if you quit your job or get laid off or fired, because your coverage in not employer-sponsored.

What happens to my coverage if I retire?

Answer: You will not lose coverage as a result of retiring or becoming eligible for Medicare. Benefits for covered services that are not covered by Medicare will continue to be paid as usual.

However, benefits for covered services that are covered by Medicare will be paid based on whether the provider accepts Medicare assignment or not.

If the health care provider accepts Medicare assignment, the combined benefit paid by Medicare and CareFirst will not exceed the Medicare approved amount for the particular covered service.

If the health care provider does not accept Medicare assignment, the combined benefit paid by Medicare and CareFirst will not exceed the Medicare limiting charge defined by Medicare for the covered service.

What happens to my coverage if I turn 65?

Answer: You will not lose coverage as a result of reaching the age of 65 or becoming eligible for Medicare. Benefits for covered services that are not covered by Medicare will continue to be paid as usual.

However, benefits for covered services that are covered by Medicare will be paid based on whether the provider accepts Medicare assignment or not.

If the health care provider accepts Medicare assignment, the combined benefit paid by Medicare and CareFirst will not exceed the Medicare approved amount for the particular covered service.

If the health care provider does not accept Medicare assignment, the combined benefit paid by Medicare and CareFirst will not exceed the Medicare limiting charge defined by Medicare for the covered service.

What if I become disabled?

Answer: Initially, there is no change to your coverage if you become disabled. Benefits for covered services that are not covered by Medicare will continue to be paid as usual.

However, benefits for covered services that are covered by Medicare will be paid based on whether the provider accepts Medicare assignment or not.

If the health care provider accepts Medicare assignment, the combined benefit paid by Medicare and CareFirst for will not exceed the Medicare approved amount for the particular covered service.

If the health care provider does not accept Medicare assignment, the combined benefit paid by Medicare and CareFirst will not exceed the Medicare limiting charge defined by Medicare for the covered service.

Is my child covered while in college?

Answer: Full-time college students are covered until age 25. However, if your child gets married or enters the military, coverage will expire at the end of the period for which CareFirst has accepted premiums.

How do I obtain a copy of my Certificate of Coverage?

Answer: You can:
a) Contact the plan administrator if you are in a group plan; or
b) Call Member Services if you have individual coverage.

How long can my child be covered if he or she has disabilities?

Answer: A disabled child, who was covered under your policy before age 19 (or 25 if a full-time student) remains covered as long as you pay premiums for the child.

What if my spouse and I divorce?

Answer: If your spouse is the policyholder, your coverage will expire at the end of the period for which CareFirst has accepted premiums. If you are the policyholder, coverage for your spouse will expire at the end of the period for which CareFirst has accepted premiums.

Do I have coverage for pre-existing conditions?

Answer: Services to treat a pre-existing condition (or complications related to a pre-existing condition) are eligible for coverage once you have been covered for nine months. Coverage is not provided for pre-existing conditions within the first nine months of your health benefit plan.

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ID Number Conversion to Non-SSN

Why is CareFirst replacing my identification (ID) number?

Answer: Identity theft using Social Security numbers is a growing problem. To protect your privacy and security, CareFirst is in the process of replacing all subscriber* ID numbers with numbers not based on your Social Security number.

*A subscriber is the person who holds a contract with CareFirst. A member is anyone in the subscriber's family who may be covered under that contract.

What will my new number look like?

Answer: Your new number will continue to begin with an alpha prefix followed by nine numeric digits (e.g. XIC987654321).

Will my dependents receive new ID numbers as well?

Answer: Only the subscriber who holds the contract with CareFirst will receive a new ID number. All dependents covered under the contract will continue to use the subscriber's number.

Will I receive a new member ID card?

Answer: Yes, as soon as your new number is assigned, you will receive a new member ID card. Please continue to use your current ID number and card until the new card arrives. Due to the large number of subscribers affected, the process will continue throughout 2005.

Will CareFirst still use my Social Security number?

Answer: Yes, CareFirst will still continue to use your Social Security number internally. We may also require you to provide your Social Security number on documents such as enrollment forms, and Flexible Spending Account forms. CareFirst has adopted and enforces a strict Privacy Policy intended to safeguard the confidentiality of information that is necessary to operate our business.

What if I live in a state where legislation banning the use of Social Security numbers has already been passed?

Answer: If you live in one of these states, you will receive a new ID number and card according to your state’s legislative requirements. If you believe that you should have received a new ID number and have not yet, please contact your HR benefits administrator or call Member Services at the phone number listed on your member ID card.

Does my doctor know to use the new number when submitting my claims?

Answer: We are informing doctors and other health care providers that we are changing your ID number and they should submit the new ID number on claims. However, you should always show your member ID card to your doctor or health care provider at every visit.

If I submit my own claims, what number should I use?

Answer: Include the new ID number on your claim to ensure the claim is filed accurately and to minimize claim payment delays.

Should I show my new member ID card to my doctor?

Answer: Yes, show your new member ID card to your doctor and other health care providers at your next visit. The information on the card will enable the provider to file the claim accurately and minimize claim payment delays.

What should I do when I receive my new member ID card?

Answer: 1. When you receive your new member ID card, take a moment to review the information on it. If you find that your information is listed incorrectly, please contact the Member Services Department at the number listed on your ID card.

2. Destroy your old ID card upon receipt of the new card.

3. Show your new ID card to your doctor and other health care providers at your next visit.

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Member Services

What are your Member Services hours?

Answer: Our Member Services department is available Monday - Friday, 7 a.m. - 7 p.m., EST.

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Pharmacy

How do I get a list of Preferred Drugs?

The Personal Comp plan does not include a prescription drug card program with a Formulary. Once you meet your medical deductible, you can obtain drugs from any pharmacy and pay a 20% coinsurance. CareFirst BlueCross BlueShield (CareFirst) pays the remaining 80% up to a $500 maximum per year. You pay for the entire drug cost up front and submit a claim to CareFirst for reimbursement.

How do I get prescriptions filled through a mail order pharmacy?

There is no mail order pharmacy program available under Personal Comp.

What is the difference between generic and brand-name drugs and how does that difference affect my benefits?

A brand name drug is a prescription drug that has been patented and is only available through one manufacturer or distributor. A generic drug is any drug approved by the FDA that has the same bio-equivalency as a specific brand name drug.
With the Personal Comp plan, the member pays the same coinsurance amount regardless of whether the drug is brand-name or generic.

If I am going to be out of town for an extended time, how do I get an extra supply of drugs to cover me through that period?

There is no utilization review on the drug program under the Personal Comp plan. You pay for your drugs up front and submit your claim for reimbursement to CareFirst. After you meet your medical deductible, you can obtain drugs from any pharmacy and pay a 20% coinsurance. CareFirst pays the remaining 80% up to a $500 maximum per year. You pay for the entire drug cost up front and then submit a claim to CareFirst for reimbursement.

Can I get reimbursed for drugs I got from a pharmacy not in the network?

The drug program under the Personal Comp plan does not use a network. You may go to any pharmacy. You pay the entire drug cost up front and then submit a claim to CareFirst for reimbursement.

What is the Preferred Drug List and how does that affect me?

There is no Preferred Drug List in the Personal Comp plan.

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