BlueChoice Opt-Out Plus HRA (Open Access)
Note: The information below briefly describes important features about this health care program. It is not a contract. A detailed description of benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions.
BlueChoice Opt-Out Plus HRA is a point-of-service (POS) plan that provides the cost savings of an HMO with the flexibility to choose any provider - even those outside the CareFirst BlueChoice network. In addition, this plan also features the advantages of an employer-sponsored Health Reimbursement Arrangement (HRA). And, because this is an "Open Access" plan, members also have the freedom to see network providers without a referral from a primary care physician (PCP)*.
While members are still required to identify a PCP upon enrollment, BlueChoice Opt-Out Plus HRA offers members the flexibility to choose their health care providers each time treatment is needed. When care is received from the PCP, specialists, hospitals and other providers who participate in the CareFirst BlueChoice provider network, a lower out-of-pocket cost is incurred. For a higher out-of-pocket cost, members also have the freedom to choose a health care provider outside the CareFirst BlueChoice network. It's the member's choice.
- Freedom to choose any doctor, specialist or hospital - anytime you wish
- 365 days of hospital coverage
- No referrals needed to see a plan specialist*
- No claims to file when visiting a CareFirst BlueChoice or a CareFirst BlueCross BlueShield participating provider
- No balance billing for out-of-network services by CareFirst BlueCross BlueShield providers. You can see a provider who is not in the Blue Cross and Blue Shield network, but you may pay a higher out-of-pocket cost and you typically must file your own claims.
- Preventive Care and Wellness Benefits:
- Annual routine examinations and office visits
- Well-child care and immunizations
- Women's health coverage, such as routine mammograms and Pap tests
- Men's health coverage, including routine prostate cancer screenings
- Discount dental program offers BlueChoice members savings of 20% to 40% on dental services.
- Tier 1 - Generic drugs (lowest out-of-pocket cost) $
- Tier 2 - Preferred brand name drugs (higher out-of-pocket cost) $$
- Tier 3 - Non-preferred brand name drugs (highest out-of-pocket cost) $$$
Plans typically have some member out-of-pocket costs in the form of copayments, coinsurance, deductibles or annual maximums. Please refer to your Evidence of Coverage for more information.
- Offers members financial control over spending their health care dollars
- Employer-funded arrangement that provides members with first-dollar coverage
- No "use it or lose it provision" like a flexible spending account (FSA). Money not used in your HRA can be rolled over to the following year.*
- HRA funds can be used for all qualified medical expenses, including traditional medical coverage, as well as eye glasses, dental procedures, prescription drug coverage and over-the-counter medication.**
- Employees decide where and how their health care funds are spent while still benefiting from the Blue Cross and Blue Shield provider discounts.
My Account - Allows you to:
Review eligibility and benefits
Check the status of a claim
Request a new ID card
My Care First - Provides health and wellness information along with health risk assessment and health goal-setting tools.
Options Discount Program - Learn about discounts on services such as laser vision correction, fitness club memberships, weight loss programs, cosmetic dentistry and more.
Find a Provider - This provider directory is updated every two weeks.
Prescription Drug Information - Look up your prescription drug coverage levels and learn how to save money on your prescription drugs.
- No-cost preventive services for children and adults
- Disease management programs for members with chronic asthma, diabetes, congestive heart failure or coronary heart disease
- Vitality member magazine
- Health education programs
- Discounts on alternative therapies: Options provides discounts on alternative therapies including acupuncture, massage therapy and chiropractic care. It also provides discounts for fitness center memberships and weight loss programs.
- 24/7 Advice: FirstHelp gives you 24-hours a day, 7-days a week health care advice from registered nurses who can answer your health care questions and help guide you to the most appropriate care.
- DHMO Dental
- Preferred (PPO) Dental
- Traditional Dental
- BlueVision provides vision coverage for members of the CareFirst BlueChoice medical plan and requires only a copayment for a routine examination and provides discounts on frames, lenses and contact lenses.
- BlueVision Plus is an enhanced vision plan that may be purchased separately. BlueVision Plus provides a routine eye examination and the opportunity to receive one pair of eyeglasses or a supply of contact lenses for a single copayment during each benefit period.
*While a referral is not needed to visit plan specialists when receiving services rendered in an office setting, pre-authorization may be needed for certain services such as mental health and substance abuse treatments and non-emergency hospitalizations, among others. Please refer to the benefits booklet (also called Evidence of Coverage) for the specific services that require pre-authorization.
** Specific feature of the HRA are determined by your employer, not by CareFirst BlueChoice. See your benefits manager for details.
For more information about this plan, contact our Member Services Department at the phone number on your member ID card.