BlueChoice HMO (Referral-based)

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.

BlueChoice (HMO) provides the cost savings of an HMO and the flexibility to choose a provider from a network of over 2,600 primary care physicians (PCPs), specialty care from over 14,000 participating specialists and hospital care from 55 area hospitals. Members are required to choose a PCP upon enrollment.

The PCP will coordinate routine care and provide treatment for a variety of medical conditions. If more specialized care is required, the PCP will refer to a participating specialist in the CareFirst BlueChoice network. When outside of the CareFirst BlueChoice service area, benefits are available for emergency or urgent care only. This plan is available to individuals and groups.

Advantages:

  • No claim forms to file
  • 365 days of hospital coverage
  • 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, 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 drugs (lowest out-of-pocket cost) $
  • Tier 2 - Preferred brand name drugs (higher out-of-pocket cost) $$
  • Tier 3 - Non-preferred brand name drugs (highest out-of-pocket cost) $$$

Plans typically have some member out-of-pocket costs in the form of copayments, coinsurance, deductibles or annual maximums. Please refer to the Evidence of Coverage for more information.

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
  • Great Beginnings program for expectant mothers
  • Discounts on alternative therapies: Options provides discounts on alternative therapies including acupuncture, massage therapy and chiropractic care. It also provides discounts for fitness center memberships and weight loss programs.
  • 24/7 Advice: FirstHelp offers health care advice 24-hours a day, 7-days a week. Registered nurses are available to answer health care questions and help guide members to the most appropriate care.

Dental Plans May Be Purchased Separately:

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

Routine Vision Benefits:

  • BlueVision
  • BlueVision Plus

Frequently Asked Questions:

  • Review the Frequently Asked Questions to get answers regarding this plan.

Member Handbook:

For more information about this plan, contact our Member Services Department at the phone number on your member ID card.

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