BlueChoice Opt-Out Open Access (POS)

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

BlueChoice Opt-Out Open Access is a plan that offers the cost savings of an HMO and the freedom to visit any provider without a referral from a primary care physician (PCP). Members are required to choose a PCP upon enrollment.

With BlueChoice Opt-Out Open Access, members will pay a lower out-of-pocket cost when they receive care from providers who participate in CareFirst BlueChoice's network. They may also receive care outside the BlueChoice network, from any provider, but they will pay a higher out-of-pocket cost. With the Open Access feature, members do not need a referral from their PCP to receive most in- or out-of-network care. + This plan is only available to groups.

Advantages:

  • Freedom to choose any doctor, specialist or hospital - anytime members wish
  • 365 Days of Hospital Coverage
  • No referrals needed to see plan specialists+
  • No claims to file when visiting a BlueChoice provider
  • 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
    • Men's health coverage, including routine prostate cancer screening
    • Family planning services
  • 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 $$
  • Tier 3 - Copays for nonformulary/nonpreferred brand name drugs have the highest level of copay $$$

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 gives 24-hours a day, 7-days a week health care advice from registered nurses who can answer your employees' health care questions and help guide them 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:

  • Get answers to Frequently Asked Questions regarding this plan.

Member Handbook:

*Out-of-Network benefits are not available for this service for Groups based in the District of Columbia.
*While a referral is not needed to visit plan specialists, pre-authorization may be needed for certain services. Also, speech, physical, and occupational therapy services may require a recommendation for treatment from a PCP or specialist. Please refer to the 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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