BluePreferred (PPO)

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.

BluePreferred is a preferred provider organization (PPO) health care plan that offers members the flexibility to choose their own doctor or hospital and control health care costs. Members save money when they obtain their health care from our large Preferred Provider network, and they can self-refer to any physician or provider in the network.

If members choose to have medical care provided by a physician or hospital outside of the preferred provider network, out-of-network benefits are available for covered services, although they will incur higher out-of-pocket expenses.

Advantages:

  • Members do not need to choose a Primary Care Physician (PCP) and will never need a referral.
  • Freedom to visit any doctor or hospital outside the network and still be covered. Members will just share more of the cost.
  • Access to one of the largest PPO provider networks in MD, DC, and VA area, with more than 24,000 participating providers.
  • Fewer paperwork hassles than traditional plans. All Select Preferred Providers and Participating Providers will typically file claims for members.
  • No balance billing** when using participating hospitals or providers.
  • Travel coverage. The BlueCard PPO Program allows BluePreferred members to receive in-network benefits while they live or travel outside our service area.

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

Medical Benefits:

  • Surgery
  • Hospitalization/inpatient services up to 365 days
  • Outpatient hospital services
  • Emergency care for injury and illness
  • Office visits for illness
  • Maternity care and infertility services
  • Diagnostic tests and X-rays
  • Allergy testing and injections
  • Home health care
  • Hospice care
  • Durable medical equipment
  • Medical supplies

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 copays 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:

Group BluePreferred members may select from the following dental plans:

  • Traditional Dental
  • Preferred (PPO) Dental

Individual BluePreferred members may purchase dental HMO coverage. The plan, administered by The Dental Network, Inc. (TDN), offers dental benefits for the price of a copay through a network of primary care dentists. Orthodontia coverage for adults and children is included.

Routine Vision Benefits: (for group plans only)

  • BlueVision
  • BlueVision Plus

Frequently Asked Questions:

  • Get answers to Frequently Asked Questions regarding this plan.

Member Handbook:

** 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.

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

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