Blue Rewards - You Buy Insurance Through Your Employer - Frequently Asked Questions

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Blue Rewards General Information

Answer: Blue Rewards is a program that offers you incentives for taking an active role in getting and staying healthy.
Answer: Complete these four steps within 120 days from the date your coverage begins to earn your participation-based reward!
  1. Select a primary care provider (PCP) who participates in our Patient-Centered Medical Health (PCMH) program— a program that provides your PCP with resources and tools to coordinate all your health care; leading to better health, better communication and better results.
  2. Consent to receive wellness emails.
  3. Answer an online health assessment.
  4. Complete a health screening by visiting your PCP or a CVS MinuteClinic.

To earn the additional results-based reward, you must meet certain goals based on the results of your health screening.

Answer: Log in to My Account to view your reward amount. Your reward can be used toward your annual deductible or out-of-pocket costs like copays or coinsurance related to eligible expenses (medical, prescription drug, dental and vision expenses) under your CareFirst health plan.
Answer: You have 120 days from the date your coverage begins to finish the participation-based steps necessary to earn your reward. The results-based reward must be completed before the end of your benefit period.
Answer: As long as your medical coverage becomes effective 120 days before the end of your employer’s benefit period, you will have 120 days to complete your Blue Reward steps. If your coverage becomes effective with less than 120 days remaining in the benefit period, you will have until the end of your benefit period to complete your Blue Reward steps.

Example: Your medical coverage with your new employer becomes effective November 1, 2016, but the benefit period ends December 31, 2016. You will only have until December 31, 2016 to complete your Blue Reward steps for 2016. However, your 2017 Blue Rewards will be available January 1, 2017.
Answer: You must use your Blue Reward by the last day of your benefit period as it cannot carryover to another benefit year — contact your company’s Human Resources department if you have questions about your benefit period. However, if you have any expenses that occurred on or before the end of your benefit period, you can submit claims for reimbursement up to three months after the end of your benefit period by logging in to My Account.
Answer: Once you or your covered spouse/domestic partner complete the participation-based steps, you will receive the incentive card in the mail. Only one card is issued to the policyholder but it can be used by everyone covered under your policy. Incentive cards will be replenished with funds once you or your spouse earn another Blue Reward.
Answer: Yes! As long as you complete the participation-based steps, you will earn a partial Blue Reward. Keep in mind that you have until the end of your benefit period to meet the results-based goals through a rescreening.
Answer: The Blue Rewards Terms and Use explains what you need to do to be eligible to earn your Blue Rewards. You must review and consent to these terms before completing any of the steps in the Blue Rewards process.
Answer: The Genetic Information Nondiscrimination Act (GINA) is a federal law that prohibits discrimination in health coverage and employment based on your genetic information.

The authorization ensures you understand that participation in the Blue Rewards program is voluntary and not a requirement of your health coverage. A GINA Authorization is required before you provide information about your current or past health status. Information about your health status includes activities like taking a health assessment or having a health screening which may be required to earn an incentive.

Your authorization is required before you can participate in the Blue Rewards program.
Answer: The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that restricts access to individuals' private medical information. As part of HIPAA, a health plan (i.e. CareFirst) cannot share information with your employer about your participation in a wellness program without getting your written permission.

By agreeing to the HIPAA Authorization, you are allowing us to share your name and the date you complete your Blue Rewards required steps with your employer. Your personal results cannot and will never be shared with your employer. If you do not provide a HIPAA authorization, you may not be eligible for an incentive because we will be unable to notify your employer when you complete the required steps in the Blue Rewards process.

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Health Assessment

Answer:
  • Log in or sign-up for My Account
  • Click on Blue Rewards under Quick Links
  • Click Start under Health Assessment and follow the screen prompts
Answer: You are the only person who can access your health assessment online. If you consent to share your health assessment results with your PCP, we may share the data with your selected PCP.

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Incentive Card General Information

Answer: Most members will receive their incentive card within 10-14 days of completing the steps.

If you have a plan with a health savings account (HSA) option, you will typically receive the incentive card once you have met the Internal Revenue Service (IRS) minimum deductible for an HSA plan. You may be able to receive your incentive card right away if certain requirements are met. Log in to My Account to check your eligibility.
Answer: Your incentive card can be used nationwide at approved merchants, including pharmacies, doctor’s offices, dental offices, vision centers, convenience care and urgent care facilities and hospitals. Your incentive card should only be used to pay for expenses under your CareFirst health plan and you should always save your receipts.
Answer: Present your card to a qualified merchant or provider, and they will swipe your card to pay for your purchase. If asked, select "credit," to use your card without a personal identification number (PIN). If you have elected to set up a PIN and would like to use it, you may do so by selecting "debit." Funds for eligible expenses will be transferred directly to the provider or merchant from your card balance.
Answer: The incentive card is a convenient way to lower your out-of-pocket expenses. It allows payment for health care expenses at the time of service. Rather than paying out-of-pocket for eligible expenses and getting reimbursed later, the incentive card allows for direct payment. Remember, the incentive card pays for eligible health care expenses up to the total reward amount earned by the individual member and/or family.
Answer: No, you can only use your incentive card to pay for eligible expenses covered under your CareFirst health plan. Your incentive card cannot be used for health care expenses with another insurance carrier. For example, if your dental coverage is with another insurance carrier, you cannot pay for dental copays/coinsurance under that plan with your incentive card.
Answer: Yes! As long as you remain a CareFirst member you should hold onto your CareFirst incentive card. The card will be reloaded with funds every year once you earn another Blue Reward.
Answer: Yes! Always hold on to your itemized receipts in case further documentation is requested. The receipt must contain the following information:
  • Patient name
  • Date of service
  • Name and address of service provider or merchant
  • Description of the service or expense provided
  • Amount charged

Simply log in to My Account and click on Blue Rewards under Quick Links. Select View Payments and then View Balances and Transactions to view your incentive account balance.

Note: Non-itemized receipts, credit card receipts and cancelled checks alone do not provide proper proof of the expense.

Answer: If you forget your card at home, just make sure that you hold onto your receipts. You can submit for reimbursement by logging in to My Account.
Answer: Yes. A fee may apply for any replacement cards. To order a replacement card, contact the Member Service Center at 855-234-7719. Please note only one card can be issued to the policyholder for all covered members under your policy.
Answer: Yes. The card will need to be activated using the instructions provided with the card.
Answer: No, your Blue Reward cannot be transferred to another person or carry over to a new plan year. However, family members on the same policy have one combined incentive card that can be used by any member of the family.
Answer: No, the Blue Reward does not have a cash equivalent. You are not able to exchange your Blue Reward for cash or any cash equivalent. However, you will be able to use your Blue Reward to pay for qualified medical expenses under your CareFirst health plan within your benefit period.
Answer: To process your incentive card, we must have the policyholder’s Social Security Number (SSN). The policyholder's SSN is needed to uniquely identify each card holder and enable activation, balance inquiries and other administrative tasks. This information will never be used for any other reason and has the highest security encryption available to protect it.
Answer: No, only the policyholder’s SSN is required to process your incentive and have the card sent to you.

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Patient-Centered Medical Home (PCMH)

Answer:
  • Log in or sign-up for My Account
  • Click on Blue Rewards under Quick Links
  • Click Start under Select a PCMH PCP and follow the screen prompts
Answer: When you choose a PCMH provider, the focus is on improving your overall health and preventing health problems before they begin. PCPs who participate in the PCMH program are committed to care quality which can lead to long-term cost savings for our members.

Additionally, these doctors can help you take an active role in your health through coordinated care and access to the tools and resources to design custom treatment plans, directing you to the proper care centers and closely monitoring your health conditions with the help of a large network of specialized nurses.
Answer: To locate a PCMH PCP, use our Find a Doctor search tool. When you search, you can filter by PCMH PCPs. You see a PCMH logo next to those PCPs who participate in the program.
Answer: Provider participation in PCMH is voluntary. All providers in the CareFirst network must meet stringent credentialing requirements that are separate from the PCMH and Blue Rewards programs. A provider’s lack of participation in PCMH should not suggest he/she does not provide quality health services.

Your PCP can enroll in the PCMH program and CareFirst would be happy to reach out to your provider to explain and invite them into the program. Please contact Member Service at the telephone number on the back of your ID card. Provide Member Service with your doctor's name and address (if available) and we will reach out to him/her.
Answer: You are not required to select a PCP as part of your PPO or Advantage product; however, in order to earn your Blue Reward the selection of a PCMH PCP is required.

If you are outside of the service area (MD, D.C., Northern VA), you should select a PCP who specializes in general practice, family practice, internal medicine, pediatrics or geriatrics from the BlueCard® national PPO network.
Answer: Unfortunately, there aren't any exceptions. In order to earn your Blue Reward, you must select a provider who participates in the PCMH program. You have the option to not participate in the Blue Rewards program if you do not wish to change providers.

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Health Screening

Answer:
  • Log in or sign-up for My Account
  • Click on Blue Rewards under Quick Links
  • Click Start under Health Screening. Decide whether you will complete your screening with your PCMH PCP or at a CVS MinuteClinic and follow the appropriate prompts in My Account.
    • If you decide to visit your PCMH PCP, call his/her office to schedule lab tests needed to complete your screening (blood glucose).
    • If you decide to visit CVS MinuteClinic, your lab work will be completed during your visit.
  • Bring the Health Screening Form (available in My Account) to your health screening.
  • After your health screening, you may need to enter your results to earn your reward:
    • If you completed your health screening with your PCMH PCP or a CVS MinuteClinic located outside of MD, DC or Northern VA, you must log in to My Account and enter your screening results.
    • If you completed your health screening at a CVS MinuteClinic within MD, DC or Northern VA, your results will be automatically entered in My Account for you within 48 hours of your screening.

CVS MinuteClinic is an independent company that provides medical services to CareFirst members.

Answer: Yes, your provider may charge a fee to complete your evaluation form. CareFirst advises providers not to charge a fee, but the providers make this decision—not CareFirst.
Answer: Testing your cholesterol is encouraged as it is one of the leading indicators of heart disease; however, there is no medically agreed-upon standard so it is not part of the Blue Rewards program. If you, or your provider, choose not to measure cholesterol, you will still be eligible for your reward.
Answer: Yes! As long as you complete the four steps, you will earn a portion of your Blue Rewards. Keep in mind that you have until the end of your benefit period to meet the results-based goals through a rescreening.
Answer: Yes, you should keep your Health Screening Form until the end of your benefit period.
Answer: Not necessarily; you should contact your doctor to see what he/she recommends. Your doctor may decide you can use your recent results to complete the Health Screening Form. However, in order to earn your reward, you must make sure your Health Screening Form is signed by your PCMH PCP and is submitted within your current benefit period.

If your doctor determines you should have another physical appointment, the appointment should be considered preventive and there should be no additional charge to you.

Answer: If you don’t meet every health goal during your health screening, don’t worry! You can still earn an additional results-based reward by working with your PCMH PCP. Discuss your results with your PCP and establish an action plan to make progress. Before the end of your benefit period, you must visit your PCP to check your progress and submit your updated results in My Account in order to earn an additional reward.
Answer: If you didn’t meet all of the health goals, you can still earn your results-based reward by working with your selected PCP to develop an action plan that addresses how you will approach each of the goals you did not meet. Your PCP can help you determine which of the following options is most appropriate:
  • 1. Meet the standard health goal – Your doctor can choose this option if they feel you should meet the standard goal(s) that are listed in My Account;
  • 2. PCP sets a new goal – Your doctor can provide you with a new goal if it is not medically advisable for you to meet the standard goal(s); or
  • 3. PCP provides a waiver – You may be provided a waiver if your PCP doesn’t recommend that you achieve certain goals.

After you have an action plan in place, you will need to enter it into My Account. You have until the end of your benefit period to meet the goal(s) on your action plan and be rescreened (except for goal(s) where your PCP provided a waiver). When you believe you have achieved the goal(s) listed in your action plan, you should make an appointment with your PCP for a rescreening.

Example: If you did not meet the standard goal for BMI, establish an action plan with your doctor to lower your BMI before the end of your benefit period. Once you believe you’ve met the goal, set-up a rescreening visit with your PCP to confirm. Have your PCP fill out a Health Screening Action Plan form with your updated result from the rescreening. If you met the goal, log in to My Account and submit your updated result(s) before the last day of your benefit period to earn the results-based reward.

Answer: A rescreening is a follow-up appointment with your PCMH PCP to check your progress against your action plan. By visiting your doctor, he/she will determine whether you have met the new goal(s).

For your rescreening appointment, you must bring the Health Screening form (available in My Account). Your PCP will complete the form and, if you met the new goal(s), you will need to submit your results in My Account before the end of your benefit period.

Answer: If it is not medically advisable for you to meet the standard goal before the end of your benefit period, your PCP can provide a new goal for you to meet. As long as you meet that goal and submit the results before the end of your benefit period, you will earn your results-based reward.

Example: Your current BMI is 35; however your PCP advises a BMI of 32 is achievable for you before the end of your benefit period.

Answer: If your PCP determines it is not advisable to meet a certain health measure, he/she can provide a waiver for that measure. As long as you submit the waiver before the end of your benefit period, you will earn your results-based reward.

Example: If you are allergic to eggs, your doctor may provide you with a waiver stating he/she does not recommend you receive the flu vaccine. In that case, you would submit your waiver to earn your reward.

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Managing Your Incentive Card

Answer: Log in to My Account and select Blue Rewards under Quick Links. Click on View Payments from the landing page and then select View Balances and Transactions, which will send you to the BenefitWallet** website.
Answer: No, the card will only work to pay for transactions that are equal to or less than your balance. So, if the amount of your purchase exceeds the balance remaining on your card, you will not be able to use the incentive card to pay for it. You can pay out of pocket then submit a reimbursement request to use the balance on your card. Please see below for additional details regarding reimbursements.
Answer: Yes, if you paid out-of-pocket for an eligible expense during your benefit period, you can be reimbursed from your Blue Rewards account balance.
Answer: Log in to My Account and select Blue Rewards under Quick Links. Click on View Payments from the landing page and then select View Balances and Transactions, which will send you to the BenefitWallet** website.
  • Under the Quick Links section, select Make a Payment/Add a Claim
  • Fill in the information about the service you are requesting reimbursement for including:
    • Who the service was performed for
    • Claim amount
    • Provider
    • Date of service
    • Payment recipient (Explanation of Benefits/itemized receipt)
  • Provide documentation of the expense via upload, fax or mail
    • Upload corresponding receipt via the website
    • Print the claims form and fax accompanying receipt for reimbursement to 855-344-6176
    • Print the claims form and mail receipt to Claims Department, P.O. Box 1924, Windermere FL, 34786
Answer: An eligible expense must be incurred within the benefit period in which you earned your Blue Reward. In addition, you have a 90-day grace period to allow you time to submit receipts for reimbursement. The 90-day grace period begins at the end of the benefit period.
  • Example: Your benefit period begins on January 1 and ends on December 31
    • Eligible expenses are those that occur between January 1, 2016 - December 31, 2016
    • Your grace period begins on January 1, 2017 and ends on March 31, 2017
      • You are able to request reimbursement during this window for expenses that were incurred between January 1, 2016 and December 31, 2016
Answer: Once you have placed a request for reimbursement, it will take 10-14 days for the claim to be reviewed, approved and for you to receive payment.
Answer: If you have used the card and more documentation is needed, you will receive an email from BenefitWallet** requesting additional documentation.

To view claims that need more documentation, your homepage shows your Recent Claims Activity. Any claims that require additional documentation will show a status that additional action is needed.
Answer: Log in to My Account and select Blue Rewards under Quick Links. Click on View Payments from the landing page and then select View Balances and Transactions, which will send you to the BenefitWallet** website. Select the Claims Center tab. You will have the option to upload, fax or mail documentation in the form of an Explanation of Benefits or itemized receipt.
  • Upload corresponding receipt via the website
  • Print the claims form and fax accompanying receipt for reimbursement to 855-344-6176
  • Print the claims form and mail receipt to Claims Department, P.O. Box 1924, Windermere FL, 34786
Answer: If you don't have documentation, you will be required to refund your account for that transaction. You will be notified by email or by mail if this occurs with directions on how to resolve your account.

You must provide the receipts within the time requested or the transaction will be considered ineligible, and you will be required to refund the amount of the transaction. If you fail to submit required receipts, your card will be suspended.
Answer: Log in to My Account and select Blue Rewards under Quick Links. Click on View Payments from the landing page and then select View Balances and Transactions, which will send you to the BenefitWallet** website. Select the Claims Center tab to view more details about which claims require repayment.
  • Print the claims form for the claim(s) that require repayment
  • Mail the claims form along with your personal check, money order or certified check payable to the address on the form
Answer: If you fail to refund the account, your card will be suspended, and the amount of the expense(s) that are missing documentation will be reported to your employer and may be added to your W-2.

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* The CareFirst Blue Rewards Visa® Incentive Card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. This card may not be used everywhere Visa debit cards are accepted. No cash access permitted. The Bancorp Bank; Member FDIC

** BenefitWallet is an independent company that manages and administers the incentive card on behalf of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members.

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