Blue Rewards - You Buy Your Own Health Insurance - 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 to earn your Blue Reward!
  1. Select a primary care provider (PCP) who participates in our Patient-Centered Medical Home (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.

Keep in mind you have 120 days from the date your coverage begins to finish the reward process.

Answer: You and your covered spouse/domestic partner can each earn $150 that can be applied toward your annual deductible or out-of-pocket costs like copays or coinsurance associated with your CareFirst coverage.
Answer: You have 120 days from the date your coverage begins to complete the steps necessary to earn your reward.
Answer: As soon as you pay your initial premium payment, you will be eligible to begin your Blue Reward steps.
Answer: Yes! As long as you choose a plan from CareFirst, it does not matter whether you enroll on a State Exchange or directly through CareFirst.
Answer: Yes! As long as you choose a plan from CareFirst, it does not matter whether you receive a subsidy - you are still eligible to earn your Blue Reward.
Answer: You must use your reward money by December 31 each year, as it cannot carryover to another benefit year. The incentive card funds must be used for expenses that are incurred within your benefit period.

You will have a 90-day grace period at the end of your benefit period to submit expenses that were incurred within the benefit period. This means if you have any expenses that occurred on or before December 31, you can submit reimbursements until March 31 of the following year by logging into My Account. However, if you terminate your coverage before December 31, you have only until the end of the benefit period to submit expenses.
Answer: Once you or your covered spouse/domestic partner complete the four 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: 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.

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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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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
  • Provide documentation (Explanation of Benefits/itemized receipt) 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 7–10 days for the claim to be reviewed, approved and for you to receive payment.

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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 cost-savings and care quality for our members.

Additionally, these doctors can help you take an active role in your health through coordinated care and access to 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 will 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 CareFirst service area (MD, D.C., or Northern VA), you should select a provider who specializes in general practice, family practice, internal medicine, pediatrics or geriatrics from the BlueCard® 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, 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.

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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—$1,350 for an individual or $2,700 for a family. 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 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 BlueCross BlueShield 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.
Answer: If you are terminated for non-payment before you receive your incentive card, your card will not be processed. For example, you earned your $150 reward on April 1. You paid your January premium, but not February or March. You would be terminated for non-payment on April 1 and would not receive your incentive card.
Answer: Let’s assume you are up-to-date on premiums and earn your incentive on April 1. You receive your card on April 15. Then, you stop paying your monthly premium and are terminated for non-payment on July 1. In this case, you would have a run-out period (90 days) to use your incentive card. If not used within the 90 days, the remaining balance on the card would be lost.

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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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