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BlueChoice Advantage

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BlueChoice Advantage

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

BlueChoice Advantage: CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc now offer a point of service plan that allows members the freedom to choose their health care provider while controlling the cost of health care. BlueChoice Advantage also allows employees seeking care outside the service area to receive in-network benefits.

This plan offers the cost savings and the freedom for members to visit any network doctor whenever they wish – with no gatekeeper and no referrals necessary.

BlueChoice 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.

Advantages
  • No PCP selection required
  • No referrals needed to see a plan specialist*
  • Freedom to choose any doctor, specialist or hospital - anytime you wish
  • No claims to file when visiting a plan provider
  • No balance billing for out-of-network services by CareFirst BlueCross BlueShield participating providers. Members can see a provider who is not in the Blue Cross Blue Shield network, but may pay a higher out-of-pocket cost and members typically must file their own claims.
  • Preventive Care and Wellness Benefits:
    • Well-child care and immunizations
    • Women's health coverage, such as routine mammograms and Pap tests, with no written referrals required for routine gynecological and obstetrical care
    • Men's health coverage, including routine prostate cancer screening
  • Discount dental program offers BlueChoice members savings of 20% to 40% on dental services
3-Tier Prescription Drug Plan
  • 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 nonformulary/nonpreferred brand name drugs have the highest level of copay
  • Option may require prescription deductible and/or annual maximum
Additional Features
  • No-cost preventive services for children and adults
  • Disease management programs for members with chronic asthma, diabetes, congestive heart failure, coronary heart disease and chronic obstructive pulmonary disease (COPD)
  • Vitality member magazine
  • Health education programs
  • 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.
  • 24/7 Advice: FirstHelp gives 24-hours a day, 7-days a week health care advice from registered nurses who can answer your employees' health care questions and help guide them to the most appropriate care.
Dental Plans May Be Purchased Separately
  • DHMO Dental
  • Preferred (PPO) Dental
  • Traditional Dental
Routine Vision Benefits
  • 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.

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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.