BlueChoice HMO Open Access
BlueChoice HMO Open Access provides the cost savings of an HMO and the freedom to see network providers without a referral from a primary care physician (PCP). Members have the flexibility to choose a provider from a network of over 26,000 PCPs and 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 network. With the Open Access feature, members don't need a referral from their PCP to visit most CareFirst BlueChoice specialists.+ When members are outside of the CareFirst BlueChoice service area, benefits are available for emergency or urgent care, only. This plan is only available to groups.
- 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 screening
- Discount dental program offers BlueChoice members savings of 20% to 40% on dental services.
3-Tier Prescription Drug Plan:
- 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 $$
- Tier 3 - Copays for nonformulary/nonpreferred brand name drugs have the highest level of copay $$$
- Option may require prescription deductible and/or annual maximum
- 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 gives you health care 24-hours a day, 7-days a week 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
Routine Vision Benefits:
- 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.
- BlueChoice HMO Open Access (932KB, 40 pgs.)
*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.
For more information about this plan, contact our Member Services Department at the phone number on your member ID card.
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