BlueChoice (HMO) Open Enrollment (for residents of the District of Columbia only)
Note: The information below briefly describes important features about this health care program and are for informational purposes only. 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. All benefits are subject to BlueChoice medical policy, medical necessity determinations, and exclusions and limitations listed in the contract.
BlueChoice Open Enrollment is a Health Maintenance Organization (HMO) health care plan available to individuals who reside in the District of Columbia, regardless of their health condition.
It offers predictable costs, and provides coordinated care from a broad regional network of participating doctors and hospitals throughout the District of Columbia, Maryland and Northern Virginia. Members are required to choose a Primary Care Physician (PCP) upon enrollment. Members are also required to obtain referrals for specialty care.
As a member of BlueChoice Open Enrollment, you will receive a wide range of benefits including preventive care, unlimited office visits, routine physicals, outpatient surgery, pediatric care, gynecological care, prescription drug coverage, dental and vision coverage and much more.
- No medical deductible
- No claim forms to file
- No lifetime maximum- you'll have coverage throughout your membership with CareFirst BlueChoice
- Access to one of the largest HMO provider networks throughout the District of Columbia, Maryland and Northern Virginia, with more than 26,000 providers and 68 hospitals
- Predictable copays for primary care and specialist office visits and emergency room care, so you don't need to worry whether or not you can afford treatment
- No balance billing when using participating providers or hospitals
- 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 and Vision Care benefits and special discounts included with the plan
Preventive Care and Wellness Benefits:
- Routine physicals and office visits
- Well-child care and immunizations
- Women's health coverage, including routine mammograms and Pap tests, with no written referrals required for routine gynecological and obstetrical care
- Men's health coverage, including routine prostate cancer screenings
- Primary care services
- Specialist services
- Chiropractic services
- 365 days of hospital coverage
- Outpatient hospital services
- Emergency care for injury and illness
- Office visits for illness
- Diagnostic tests and X-rays
- Allergy testing and treatment
- Skilled nursing facility services
- Home health care
- Hospice care
- Mental health and addiction treatment services
- Treatment for Temporalmandibular Joint (TMJ) problems
- Treatment for morbid obesity
- Organ transplantation
- Medical devices and supplies
3-Tier Prescription Drug Plan:
Once you meet the prescription deductible, $100 for Individual coverage, $200 for Individual/Adult, Individual/Child(ren) or Family coverage, your copays will be:
- Tier 1 - Generic drugs ($10)
- Tier 2 - Preferred brand name drugs ($60)
- Tier 3 - Non-preferred brand name drugs ($80)
Please refer to the Evidence of Coverage for more information.
As a BlueChoice Open Enrollment member, you have an Individual Select Preferred Dental plan, which offers coverage of preventive and diagnostic dental services, including examinations, cleanings, and x-rays, and your choice of 3,600 participating providers.
Routine Vision Benefits:
BlueChoice Open Enrollment offers you eye care benefits as part of your medical plan, through our network administrator, Davis Vision, Inc. For annual routine eye exams, just call and make an appointment with one of the participating providers and pay the $10 copay at the time of service. Additionally, you receive discounts of approximately 30% on eyeglass lenses or contact lenses.
- 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)
- Online access to your benefits and claims through www.carefirst.com/myaccount.
- Vitality member magazine
- Health education programs
- Discounts on alternative therapies: Our Options program provides discounts on alternative therapies including acupuncture, massage therapy and chiropractic care. It also provides discounts for fitness center memberships and weight loss programs.
- BlueChoice HMO (1.3MB, 44 pgs.)
Purchasing the Plan:
For information about purchasing this plan, please call 410-356-8000 or toll-free at 1-800-544-8703.
Note: The BlueChoice Open Enrollment plan is only available to residents of the District of Columbia. The information provided on the application is subject to verification. To do so, you acknowledge that CareFirst could use information from our own systems, or information available from a commercial third party data provider. Further, you acknowledge that this information will be used, in part, to determine eligibility.
You must provide proof of residency in the District of Columbia with your application. Acceptable forms of documentation include:
- A copy of the front of your current DC driver's license or DC ID card
- A copy of your utility bill
- A copy of your rental agreement
- A copy of your voter registration card
- A copy of your DC Resident Income Tax Return
- A copy of your property taxes
Enrollment in the Open Enrollment plan will be capped at 2,500 contracts.
For more information about this plan, contact our Member Services Department at the phone number on your member ID card.
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