BlueChoice HMO HRA (Open Access)

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

BlueChoice HMO HRA provides the cost savings of an HMO, combined with the advantages of an employer-sponsored Health Reimbursement Arrangement (HRA). And, because this is an "Open Access" plan, members have the freedom to see network providers without a referral from a primary care physician (PCP). They also have the flexibility to choose a provider from a network of over 2,600 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 can coordinate specialty care using a network of specialists within the CareFirst BlueChoice provider network. With the Open Access feature, members don't need a referral from their PCP to visit most BlueChoice specialists.* When members are traveling outside of the CareFirst BlueChoice service area, benefits are available for emergency or urgent care, only. This plan is only available to groups.

Advantages

  • No referrals needed to see plan specialists*
  • 365 days of hospital coverage
  • No claim forms to file
  • Preventive Care and Wellness Benefits:
    • Annual 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 screenings
  • 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 your Evidence of Coverage for more information.

Advantages of using a Health Reimbursement Arrangement:

  • Offers members financial control over spending health care dollars
  • Employer-funded arrangement can provide members with first-dollar coverage.*
  • No "use it or lose it provision" like a flexible spending account (FSA). Money not used in a member HRA can be rolled over to the following year.*
  • HRA can be used for all qualified medical expenses, including traditional medical coverage, as well as eye glasses, dental procedures, prescription drug coverage and over-the-counter medication.**
  • Employees decide where and how their health care funds are spent while still benefiting from the Blue Cross and Blue Shield provider discounts.

Online Tools and Resources:

My Account - Allows you to:

  • Review eligibility and benefits
  • Check the status of a claim
  • Request a new ID card

My Care First - Provides health and wellness information along with health risk assessment and health goal-setting tools.

Options Discount Program - Learn about discounts on services such as laser vision correction, fitness club memberships, weight loss programs, cosmetic dentistry and more.

Find a Provider - This provider directory is updated every two weeks.

Prescription Drug Information - Look up your prescription drug coverage levels and learn how to save money on your prescription drugs.

Additional Features:

  • No-cost preventive services for children and adults
  • Disease management programs for members with chronic asthma, diabetes, congestive heart failure or coronary heart disease
  • 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 gives you advice 24-hours a day, 7-days a week health care advice from registered nurses who can answer your health care questions and help guide you to the most appropriate care.

Dental Plans May Be Purchased Separately:

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

Vision Plans:

  • 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.

* 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 your benefits booklet (also called Evidence of Coverage) for the specific services that require pre-authorization.

** Specific feature of the HRA are determined by your employer, not by CareFirst BlueChoice. See your benefits manager for details.

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