BlueChoice Opt-Out Open Access (POS)
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 Opt-Out Open Access is a plan that offers the cost savings of an HMO and the freedom to visit any provider without a referral from a primary care physician (PCP). Members are required to choose a PCP upon enrollment.
With BlueChoice Opt-Out Open Access, members will pay a lower out-of-pocket cost when they receive care from providers who participate in CareFirst BlueChoice's network. They may also receive care outside the BlueChoice network, from any provider, but they will pay a higher out-of-pocket cost. With the Open Access feature, members do not need a referral from their PCP to receive most in- or out-of-network care. + This plan is only available to groups.
- Freedom to choose any doctor, specialist or hospital - anytime members wish
- 365 Days of Hospital Coverage
- No referrals needed to see plan specialists+
- No claims to file when visiting a BlueChoice provider
- Preventive Care and Wellness Benefits
- 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
- Family planning services
- Discount dental program offers BlueChoice members savings of 20% to 40% on dental services.
- 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 $$
- Tier 3 - Copays for nonformulary/nonpreferred brand name drugs have the highest level of copay $$$
- 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.
- DHMO Dental
- Preferred (PPO) Dental
- Traditional Dental
- BlueVision Plus
*Out-of-Network benefits are not available for this service for Groups based in the District of Columbia.
*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.