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HealthyBlue Triple Option Summary

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HealthyBlue Triple Option

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 Triple Option gives you the freedom to visit any doctor, regardless of whether they participate in one of CareFirst's provider networks. Members also have the ability to earn a Healthy Reward for living healthy lives or for taking actions to have healthier lifestyles.

Greater flexibility comes with higher costs to you, so be sure you understand the difference between a CareFirst network provider and an out-of-network doctor as the cost difference can be substantial.

Option 1 is based on the BlueChoice network and requires referrals from your PCP for Specialty care, and has the lowest cost sharing to the member. Option 2 also uses the BlueChoice network, but does not require referrals. Option 3 allows members to use any doctor outside the BlueChoice network, either CareFirst PPO providers or providers completely outside the network and is the highest cost to the member.

  • Freedom to choose any doctor, specialist or hospital - anytime you wish
  • 365 days of hospital coverage
  • Options to utilize care with and without referrals*
  • 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 at no cost under Options 1 & 2:

  • 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

3-Tier Prescription Drug Plan:

  • HealthyBlue Select Generics at no cost - generics used to treat asthma, blood pressure, cholesterol, depression and diabetes
  • Tier 1 - Generic drugs (lowest out-of-pocket cost) $
  • Tier 2 - Preferred brand name drugs (higher out-of-pocket cost) $$
  • Tier 3 - Non-preferred brand name drugs (highest out-of-pocket cost) $$$

Ability to earn a reward for being healthy - up to $300 per Individual policy or up to $700 per Family.
Discount dental program offers BlueChoice members savings of 20% to 40% on dental services.
BlueVision coverage includes an annual eye exam and discounts on lenses, frames and materials.

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

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

Dental Plans:

  • DHMO Dental
  • Preferred (PPO) Dental
  • Traditional Dental

Vision Plan:

  • 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.

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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.