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HealthyBlue Advantage Summary

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HealthyBlue Advantage

Note: The information below briefly describes important features about this health care program. It is not a contract. A detailed description of your benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions.

HealthyBlue Advantage rewards you for knowing your health status and gives you choices each time you need care.

HealthyBlue Advantage allows members the flexibility to choose a health care provider when and where treatment is needed. When care is received inside the CareFirst service area members will experience the lowest out of pocket costs when they visit a BlueChoice provider. Members still have the option to access a BlueCard PPO doctor, but will be subject to higher out of pocket expenses.

Members receiving care outside the CareFirst Service area will experience the lowest out of pocket costs by accessing a national BlueCard PPO provider. Members will still have the option to opt-out of this network at a higher out-of-pocket expense.

With HealthyBlue Advantage, you can earn a financial reward by completing three simple steps. Children under the age of 2 are not eligible for the Healthy Reward.

  • Freedom to choose any doctor, specialist or hospital
  • 365 days of hospital coverage
  • No referrals* required
  • No claims to file when visiting a CareFirst BlueChoice or BlueCard PPO provider

Preventive Care at no cost when seeing a CareFirst BlueChoice provider in the service area or a BlueCard PPO provider when outside of Maryland, D.C. or Nothern Virginia:

  • 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 screening
Prescription Drug Plan
  • Select Preventive Generics available at no cost - used to treat asthma, blood pressure, cholesterol, depression and diabetes (only available with plans with a combined medical and prescription drug deductible)
  • Tier 1 - Generic copays offer the lowest cost to the member
  • Tier 2 - Copays for formulary/preferred brand name drugs are higher than for generic drugs
  • Tier 3 - Copays for non-formulary/non-preferred brand name drugs have the highest level of copay
  • Option may require prescription deductible
Additional Features
  • No-cost preventive services for children and adults
  • Wellness Discount Program - Learn about Blue365, an exciting program that offers great discounts from top retailers on fitness gear, gym memberships, family activities, healthy eating options and much 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 prescription drugs.
  • Vitality member magazine
  • Health education programs
  • 24/7 Advice: FirstHelp gives you health care advice 24-hours a day, 7-days a week from registered nurses who can answer your health care questions and help guide you to the most appropriate care.
  • My Care First - Provides health and wellness information along with health risk assessment and health goal-setting tools.
Dental and Vision Plans May Be Purchased Separately

The discount dental program offers CareFirst BlueChoice members savings of 20% to 40% on dental services.

BlueVision coverage includes an annual eye exam and discounts on lenses, frames and materials.

Dental Plans
  • DHMO Dental
  • Preferred (PPO) Dental
  • Traditional Dental
Vision Plan
  • BlueVision Plus is an enhanced vision plan that may be purchased separately by employer groups. 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.

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*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.

For more information about this plan, contact our Member Services Department at the phone number on your member ID card.