More to feel good about. Baltimore City public schools Health Care Options

Transcription

1 More to feel good about. Baltimore City public schools 2011 Health Care Options

2 Baltimore City Public Schools Open Enrollment Dates: 10/25/10 through 11/5/10 Open Enrollment Hotline available 10/18/10 through 11/5/ Important Phone Numbers for 2011 Dedicated Customer Service (410) or (800) Mailing Address CareFirst BlueCross BlueShield Mail Administrator P.O. Box Lexington, KY What s New Pre-Authorizations for Required s (Including but not limited to: Inpatient Hospitalization, Outpatient Therapies, Home Healthcare, Private Duty Nursing, etc.) (410) or (800) Magellan Behavioral Health For Mental Health Services (800) n CareFirst BlueChoice POS replacing United POS. n Dependents covered through the end of the month in which they turn 26. Attention Point of Service Members Beginning 1/1/2011, CareFirst BlueChoice will now administer the Point of Service product. Members enrolled in the United Health Care POS will automatically receive the CareFirst product effective 1/1/2011 unless another product is elected by the employee during open enrollment. If you wish to remain in the Point of Service product, all you have to do is: 1. Ensure your current primary care physicians (PCPs) (for you and your dependents) also participate in the CareFirst BlueChoice provider network (see page 15 on how to locate a provider.) 2. Complete the Primary Care Selection Form at the back of this booklet and return it to CareFirst. ii Baltimore City Public Schools 2011 Health Care Options

3 Welcome Did you know that smiling has been proven to reduce stress? It can also boost your immune system. And lower your blood pressure. If that s not enough, smiling releases endorphins which make you feel better. Well at CareFirst BlueCross BlueShield (CareFirst), we give you even more reasons to smile, by offering more of what you want from a health care plan: More choices. More experience. More doctors. At CareFirst, we aim to keep you healthy by emphasizing prevention, healthy living, early detection and early treatment. That s one of the main advantages of having CareFirst coverage. We work with you to help prevent illness and we encourage you to seek care when it is needed. You can also select your doctor from a network of physicians, specialists and hospitals located throughout Maryland, Washington, D.C. and Northern Virginia so you can visit a doctor where you live, where you work or anywhere in between. Designed for today s health conscious and busy families, your CareFirst plan will offer one less thing to worry about during your busy day. So smile. It s good for you! Baltimore City Public Schools 2011 Health Care Options 1

4 BlueChoice Point-of-Service A Plan with Predictable Costs and the Freedom to Choose You re committed to taking care of your family s health. As a Baltimore City Public Schools employee, it s time to choose a health plan with that same level of commitment. CareFirst s BlueChoice Point-of-Service offers you maximum flexibility to choose any doctor, any specialist and any hospital you wish. You determine the level of coverage. s of BlueChoice Point-of-Service n Choose from over 17,000 providers, specialists and hospitals in Maryland, Washington, D.C. and Northern Virginia. n Enjoy the freedom to visit providers outside of the BlueChoice network and still be covered but with a higher out-of-pocket cost. n No PCP referral required to see a specialist. n Receive coverage for preventive health care visits at no copay. n Avoid the unwelcome surprise of high medical costs with predictable copays and coinsurance (if applicable). n Avoid balance billing when you receive care from a CareFirst BlueChoice provider or national participating provider. n Take your health care benefits with you when you travel. n Enjoy your plan benefits when you re out of the area for 90 days with the Away from Home Care program. How Your Plan Works Establishing a relationship with one provider is the best way for you to receive consistent, quality health care. When you enroll in this plan, you will select a PCP to manage your primary medical care. Make sure you select a PCP for not only yourself but each of your family members as well. Your PCP must participate in the CareFirst BlueChoice provider network and must specialize in either family practice, general practice, pediatrics or internal medicine. Visit providers outside of the network. No need to get a referral. 2 Baltimore City Public Schools 2011 Health Care Options

5 BlueChoice Point-of-Service A Plan with Predictable Costs and the Freedom to Choose This plan has an Open Access feature, which means you have direct access to CareFirst BlueChoice specialists without needing to obtain a referral from your PCP. However, you may choose to call your PCP when you need care. Your PCP can: n Provide basic medical care. n Prescribe any medications you need. n Maintain your medical history. n Work with you to determine when you should see a specialist. n Assist you in the selection of a specialist. If you do not select a PCP for you and any of your covered family members, you may be charged a higher copayment (copay) for covered services. In-Network vs. Out-of-Network Coverage In-network benefits provide a higher level of coverage. This means you have lower out of pocket costs when you visit a CareFirst BlueChoice provider. However, the choice is entirely yours. That s the advantage of this plan. Out-of-network benefits provide a lower level of coverage in exchange for the freedom to seek care from any provider you choose. If you receive services from a provider outside of the BlueChoice network (out-of-network), you may have to: n Pay the provider s actual charge at the time you receive care. n File a claim for reimbursement. n Satisfy a higher deductible and/or coinsurance amount. The Blue Cross and Blue Shield Association, made up of Blues plans across the country, has a national network of providers, called BlueCard participating providers. If you choose to visit a BlueCard provider, you will have a lower out-of-pocket cost. Your benefits will still be paid at the out-of-network level. But the provider cannot balance bill for any difference between the allowed amount and charges. Find a national participating provider by visiting Hospital Authorization/ Utilization Management CareFirst BlueChoice providers will obtain any necessary admission authorizations for in-area covered services. You will be responsible for obtaining authorization for services provided by outof-network providers and out-of-area admissions. Call toll-free at (866) BlueChoice Point-of-Service is a product with in network HMO benefits administered by CareFirst BlueChoice, Inc. and out-of-network indemnity benefits administered by Group Hospitalization and Medical Services, Inc., doing business as, CareFirst BlueCross BlueShield (CareFirst). Each time that services are sought, you may choose to receive in-network HMO benefits or out of network indemnity benefits. Immediately Your Plan Will Start to Pay for Services The level of those benefits will depend on whether you see in network or out-of-network providers. Depending on your particular plan, you may have to pay a copay or coinsurance when you receive care. Example: Let s say you get the flu. Your Primary Care provider may typically charge $250 for your visit. However, because of their agreement with CareFirst BlueChoice, Inc., instead they charge the agreed upon fee of $120. This is called the allowed benefit for this service. Baltimore City Public Schools 2011 Health Care Options 3

6 BlueChoice Point-of-Service A Plan with Predictable Costs and the Freedom to Choose Assume your plan has a $5 copay for in network benefits, a 50% member coinsurance for out ofnetwork benefits. Office visit at an in-network CareFirst BlueChoice provider Provider s Charge Allowed *In general, out-of-network providers do not have an agreement with CareFirst BlueChoice, Inc. to accept the allowed benefit as payment in full for their services. Therefore, if you receive services from an out-ofnetwork provider, you may be balance billed based on the provider s actual charge. In addition, you may be required to pay the out-ofnetwork provider s total charges at the time of service and submit a claim to CareFirst for reimbursement. However, if you visit a BlueCard participating provider, you will be protected from balance billing, in which case your total cost for the example above would be $60. Laboratory Services You Pay (in-network copay) $250 $120 $5 Office visit at a non-bluechoice Participating provider Provider s Charge Allowed You Pay (in-network copay) $250 $120 (50% x $120) = $60 Office visit at an out-of-network provider Provider s Charge Allowed You Pay (out-of-network coinsurance) $250 $120 (50% x $120) = $60 + $130 (the portion of the out-of-network provider s charge that is above the allowed benefit) = $190 To ensure you receive the maximum laboratory benefit from your plan, you must use a LabCorp facility for any in-network laboratory services. Services performed at a facility that is not part of the LabCorp network may not be covered under your plan. Also, any lab work performed in an outpatient hospital setting will require a prior authorization from your PCP. Important Terms Allowed benefit is the amount CareFirst BlueChoice, Inc. allows for the particular service in effect on the date that service is rendered. Copay is a fixed amount a member must pay for a covered service (e.g. $5 per office visit to a PCP). Coinsurance is a percentage of the provider s charge or allowed benefit a member must pay for a covered service. LabCorp has approximately 70 locations throughout Maryland, Washington, D.C. and Northern Virginia. To locate the LabCorp patient service center near you, call (888) LAB-CORP or visit Out-of-area Coverage You have the freedom to take your health care benefits with you across the country and around the world. BlueCard, a program from the Blue Cross and Blue Shield Association, allows you to receive out-of-network benefits when you visit a BlueCard participating provider while living or traveling outside of the CareFirst BlueChoice, Inc. service area (Maryland, Washington, D.C. and Northern Virginia). The BlueCard program includes more than 6,100 hospitals and 600,000 providers nationally. In addition, members and their covered dependents planning to be out of the service area for at least 90 consecutive days can take advantage of a special program, called Away from Home Care. This program allows temporary benefits through another Blue Cross and Blue Shield plan. It provides coverage for routine services and is perfect for extended out-of-town business or travel, semesters at school or families living apart. For more information on Away from Home Care, please call Member Services at the phone number listed on your identification card. 4 Baltimore City Public Schools 2011 Health Care Options

7 Preferred Provider Network (PPN) A Referral-Free Go Anywhere Health Plan You re committed to taking care of your family s health. As a Baltimore City Public Schools employee, it s time to choose a health plan with that same level of commitment. CareFirst s Preferred Provider Network (PPN) offers you maximum flexibility to choose any doctor, any specialist and any hospital you wish. Designed for today s health conscious and busy families, the PPN plan offers one less thing to worry about during your busy day. Your PPN plan gives you the freedom to visit any provider you wish any time you wish. This means you can receive care from the provider of your choice without ever needing to select a primary care physician (PCP) or obtaining a PCP referral for specialist care. s of PPN n Access to our network of more than 23,000 doctors, specialists and hospitals in Maryland, Washington, D.C. and Northern Virginia. n No primary care physician required, and no referrals to see a specialist. n Take your health care benefits with you across the country and around the world. n Receive coverage for preventive health care visits. n Avoid balance billing when you receive care from a preferred provider. n Enjoy the freedom to visit providers outside of the PPN network and still be covered but with a higher out-of-pocket cost. How Your Plan Works In-network vs. Out-of-network Coverage The amount of coverage your PPN plan offers depends on whether you see a provider in the PPN network (preferred provider) or out of network. You will receive a higher level of benefits when you visit a preferred provider. However, the choice is entirely yours. That s the advantage of a PPN plan. No referrals. No PCPs. Coverage anywhere. Baltimore City Public Schools 2011 Health Care Options 5

8 Preferred Provider Network (PPN) A Referral-Free Go Anywhere Health Plan In-network benefits: when you use a preferred provider you have lower out-of-pocket costs. If you are out of the CareFirst BlueCross BlueShield service area, you have the freedom to select any provider that participates with a Blue Cross and Blue Shield PPN plan across the country and receive benefits at the in-network level. Out-of-network benefits: if you use an out-of-network provider you have a higher out-of-pocket cost in exchange for the freedom to seek care from any provider you choose. If you receive services from a provider outside of the PPN network (non-preferred provider), you may have to: n Pay the provider s actual charge at the time you receive care. n File a claim for reimbursement. n Satisfy a higher deductible and/or coinsurance amount. Hospital Authorization/ Utilization Management Preferred providers will obtain any necessary admission authorizations for in-area covered services. You will be responsible for obtaining authorization for services provided by non preferred providers and out-of-area admissions. Call toll-free at (866) Your s Depending on your particular plan, you may have to pay a copay or coinsurance when you receive care. Example: Let s say you get the flu. Your doctor may typically charge $500 for your visit. But because of their agreement with CareFirst, instead they charge the agreed upon fee of $300. This is called the allowed benefit for this service. You visit an in-network preferred doctor. Provider s Charge Allowed You Pay $500 $300 $5 You visit an out-of-network non-preferred doctor. Provider s Charge Allowed You Pay* (out of network coinsurance) $500 $300 (20% x $300) = $60 + $200 (the portion of the non-preferred provider s charge that is above CareFirst s allowed benefit) = $260 *In general, non-preferred providers do not have an agreement with CareFirst to accept the allowed benefit as payment in full for their services. Therefore, if you receive services from a non-preferred provider, you may be balance billed based on the provider s actual charge. In addition, you may be required to pay the non-preferred provider s total charges at the time of service and submit a claim to CareFirst for reimbursement. 6 Baltimore City Public Schools 2011 Health Care Options

9 Preferred Provider Network (PPN) A Referral-Free Go Anywhere Health Plan Out-of-Area Coverage You have the freedom to take your health care benefits with you across the country and around the world. BlueCard PPN, a program from the Blue Cross and Blue Shield Association, allows you to receive the same health care benefits when receiving care from a BlueCard preferred provider while living or traveling outside of the CareFirst service area (Maryland, Washington, D.C. and Northern Virginia). The BlueCard program includes more than 6,100 hospitals and 600,000 other health care providers nationally. Important Terms Allowed benefit is the amount CareFirst allows for the particular service in effect on the date that service is rendered. Copay is a fixed amount that a member must pay for a covered service. Coinsurance is a percentage of the allowed benefit that a member must pay for a covered service. Questions and Answers Is my doctor in the PPN network? Most doctors and hospitals in Maryland participate with the Preferred Provider Plan. Chances are your doctor or hospital is already a preferred provider. To find out, visit our website at or call your dedicated customer service department at (410) or (800) Who can sign up? You can enroll in the Preferred Provider Plan if you re an active Baltimore City Public Schools employee. Unmarried eligible dependent children can be covered through the end of the month in which they turn 26. Does CareFirst offer a Disease Management program? CareFirst, through its partner, Healthways, Inc. offers a comprehensive disease management program to Baltimore City Public Schools employees. Components of the enhanced disease management program include: n Welcome packet and call n Assessments and screening n Standards of care reminders n Action plans n Targeted educational materials n Disease newsletters and website Highly trained nurse managers are available Monday through Saturday to help evaluate participants health status, discuss the condition and support their efforts to change unhealthy behaviors. Please refer to page 13 for additional information. Baltimore City Public Schools 2011 Health Care Options 7

10 2011 Summary of s s Inpatient Hospitalization 365 medical days (Required Pre-Authorization; excludes Acute Inpatient Rehabilitation) Routine physicals (age 13 yrs. and older; One every three years) Routine OB/GYN exam One per year Office Medical visits- Primary Care Physicians (includes family/general practice, internal medicine and pediatrics) Specialist Office Visit Well-child care through age 6 (includes immunizations and vaccinations) One Annual Physical (ages 7-12 yrs.) Physical, Speech and Occupational Therapy (outpatient/office) Emergency Room charges due to accidental injury or medical emergency Preferred Provider Network In-Network benefits Out-of-Network benefits (To receive these benefits you must use the Preferred Provider network and get any required pre-authorization for selected services.) 365 days at 100% of Allowed $5 Copay per visit, then 100% of Allowed $5 Copay per visit, then 100% of Allowed $5 Copay per visit, then 100% of Allowed $10 Copay per visit, then 100% of Allowed $5 Copay per visit, then 100% of Allowed Visits Age months months years $5 Copay per visit up to $75 maximum 100% of Allowed ; 100 combined visits per calendar year (pre-authorization required after the 10th visit) $50 Copay per visit (waived if admitted), then 100% of Allowed $100 deductible per admission 80% up to $1,500 out of pocket maximum per admission then 100% Allowed 365 inpatient days BlueChoice Point of Service (POS) In-Network benefits Out-of-Network benefits (To receive these benefits you must use the BlueChoice network and get any required preauthorization for selected services.) Covered in full 50% Allowed 80% of Allowed Covered in full $5 Copay per visit, 50% Allowed 80% of Allowed Covered in full $5 Copay per visit, 50% Allowed 80% of Allowed $5 Copay per visit $5 Copay per visit, 50% Allowed 80% of Allowed $10 Copay per visit $5 Copay per visit, 50% Allowed 80% of Allowed Visits Age months months years Covered in full $5 Copay per visit, 50% Allowed $75 maximum Covered in full $5 Copay per visit, 50% Allowed 80% of Allowed ; 100 combined visits per calendar year (pre-authorization required after the 10th visit) $50 Copay per visit (waived if admitted), then 80% of Allowed $10 Copay per visit $5 Copay per visit, 50% Allowed $50 Copay (waived if admitted) $50 Copay (waived if admitted) BOLD = Healthcare Reform Requirement 8 Baltimore City Public Schools 2011 Health Care Options

11 2011 Summary of s s Diabetic Medical Supplies Invitro Fertilization (pre-authorization required; limited to 3 attempts per live birth; $100,000 lifetime maximum) Artificial Insemination (pre-authorization required; limited to 6 cycles per lifetime) Diagnostic tests, X-ray, laboratory services Outpatient Surgery Mental Health Care/ SUBSTANCE ABUSE Inpatient (pre-authorization required) Preferred Provider Network In-Network benefits Out-of-Network benefits (To receive these benefits you must use the Preferred Provider network and get any required pre-authorization for selected services.) 100% of Allowed (Lancets, test strips and glucometers) $10 Copay per visit, then 100% of Allowed $10 Copay per visit, then 100% of Allowed 100% of Allowed 100% of Allowed 100% of Allowed 100% of Allowed (Lancets, test strips and glucometers) BlueChoice Point of Service (POS) In-Network benefits Out-of-Network benefits (To receive these benefits you must use the BlueChoice network and get any required preauthorization for selected services.) Covered in full 50% of Allowed 80% of Allowed $10 Copay $10 Copay per visit, 50% Allowed 80% of Allowed $10 Copay $10 Copay per visit, 50% Allowed 80% of Allowed Covered in full 50% of Allowed 80% of Allowed Covered in full 50% of Allowed $100 deductible per admission 80% up to $1,500 out of pocket maximum per admission then 100% Allowed 365 inpatient days Covered in full 50% of Allowed Office Visits $10 Copay 80% of Allowed $5 Copay 50% of Allowed Outpatient DEPENDENT ELIGIBILITY Major Medical s 100% of Allowed 80% of Allowed Covered in full 50% of Allowed Unmarried eligible dependents are covered until the end of the month in which they turn age 26, regardless of student status. Deductibles and Percentages Applicable N/A N/A to major medical services only Baltimore City Public Schools 2011 Health Care Options 9

12 2011 Summary of s s Private-Duty Nursing (pre-authorization required) Medical Supplies (excluding diabetic medical supplies which are covered under Basic benefit as indicated above) Ambulance Service (public and private-ground only) Preferred Provider Network In-Network benefits Out-of-Network benefits (To receive these benefits you must use the Preferred Provider network and get any required pre-authorization for selected services.) I. Teachers and Public School Administrators and Supervisors Association (PSASA) Deductible - $150 per person, $400 per family, per policy year. percentage - $2,000 paid at 80% Allowed then 100% Allowed II. III. Paraprofessionals Deductible - $200 per person, $400 per family, per policy year percentage - $2,000 paid at 80% Allowed then 50% Allowed Unaffiliated Deductible - $250 per person, per policy year percentage - $30,000 paid at 100% Allowed then 50% Allowed BlueChoice Point of Service (POS) In-Network benefits Out-of-Network benefits (To receive these benefits you must use the BlueChoice network and get any required preauthorization for selected services.) Covered in full Covered in full Covered in full for emergency, if not ER $50 copay 50% of Allowed 50% of Allowed 50% of Allowed Whole Blood Covered in full 50% of Allowed Orthopedic and Prosthetic Devices Covered in full 50% of Allowed IV. American Federation of State, County, Municipal Employees (AFSCME), and City Union of Baltimore (CUB) Deductible - $200 per person, per policy year percentage - $30,000 paid at 100% Allowed then 50% Allowed This document is for summary purposes only and does not create rights not given through the benefit plan. All benefits subject to change as a result of Healthcare Reform with no prior notice. 10 Baltimore City Public Schools 2011 Health Care Options

13 Managed Care Features CareFirst offers several programs to help you make the most of your health care benefits and to ensure that you receive care in the most appropriate setting. Because some of the following services require authorization before you receive care, please follow the specific guidelines carefully to avoid penalties. Infertility Services Specific guidelines and criteria for medical necessity and eligibility apply for these services. Therefore pre authorization is required before any benefits can be provided for AI/IVF services. A pre-authorization form must be completed by the provider performing the AI/IVF services. For additional information, contact your dedicated customer service department. Hospital Admissions Before you are admitted to the hospital for a non emergency procedure of any kind, you or your provider must call CareFirst to pre-authorize your hospital admission. In an emergency, the hospital will call us. To pre-authorize your hospital stay, call (410) or (800) A representative can only tell you if hospitalization is medically necessary, not if you have benefits for care. To avoid unexpected bills for non-covered services, CareFirst recommends that you call your dedicated service department to make sure you have benefits for all inpatient care you plan to receive. Mental Health and Substance Abuse Care If you need inpatient mental health care or alcohol/ substance abuse therapy, you or your provider must call Magellan Behavioral Health Services at (800) for pretreatment authorization. If you do not call before you are admitted to a hospital, services will be denied. Private Duty Nursing and Coordinated Home Care Private duty nursing and Coordinated Home Care must be medically necessary and requires preauthorization. If you do not call for pretreatment authorization, penalties may apply. Individual Case Management When faced with a serious diagnosis or condition, you and your family have many tough choices and decisions to make. The CareFirst Case Management program can help you navigate the complex health care system and provide support during your time of need. Some of the conditions most frequently case managed include, serious trauma, rehabilitation, cancer and special needs: Our case managers will: n Work closely with you and your doctors to identify a treatment plan. n Coordinate necessary services. n Contact you regularly to see how you are doing. n Answer any of your questions. n Suggest community resources that may be available. If you feel you need this service, please call (410) or (800) Baltimore City Public Schools 2011 Health Care Options 11

14 Managed Care Features Disease Management CareFirst wants to help you achieve the best possible state of health. We know that there are many things to remember when you are living with a chronic condition. That s why our disease management programs can help you manage your condition and help you to avoid complications. We have nurses available to provide you with information and assist you in managing: n Asthma. n Diabetes. n Chronic obstructive pulmonary disease (COPD). n Congestive heart failure. n Coronary artery disease. Once you enroll, you will: n Be able to call a toll-free number 24 hours a day, 7 days a week, to speak with a registered nurse. n Receive educational materials and quarterly newsletters with information about your condition. n Receive reminders and tools to help you manage your condition. These programs are free, voluntary and confidential. Call (800) to find out if you are eligible or to enroll in one of the programs. Great Beginnings CareFirst offers case management support to members during pregnancy. The Great Beginnings program is designed to supplement the prenatal care and education you receive from your doctor during pregnancy. When you enroll in Great Beginnings, one of our case managers will contact you to review your medical history and to identify any other conditions that may affect your pregnancy. Case managers are available to answer questions Monday through Friday, 8:30 a.m. to 4:30 p.m. To find out more information about the program call (888) Vitality CareFirst s quarterly health magazine provides you with the tools you need to help achieve a happier and healthier lifestyle. Each issue is filled with useful and timely information on a variety of health-related topics. You ll learn about food and nutrition, physical fitness, recreation and preventive healthcare. You will also get to know about our company and how to get the most from your benefits and each issue is delivered right to your mailbox. Health Information on the Internet Visit our online, interactive guide to health topics called My Care First. This site offers information on nutrition, fitness, chronic illnesses, stress, mental health and much more. You ll also find support if you re trying to lose weight, quit smoking or manage your chronic illness. My Care First covers the latest developments in medicine and health. Check it out at to learn how you can maintain a healthier lifestyle. 12 Baltimore City Public Schools 2011 Health Care Options

15 FirstHelp 24-Hours Health Care Advice Line (800) Anytime, day or night, you can speak with a FirstHelp nurse. Registered nurses are available to answer your health care questions and help guide you to the most appropriate care. How FirstHelp Works Simply call (800) and a registered nurse will: Ask about your symptoms. Help you decide on the best source of care. When to Call FirstHelp First, you should call your doctor when you have a health concern. If you can t reach your doctor and have questions about your health, an illness or an urgent medical condition, a registered FirstHelp nurse is available to answer your questions and assist you in determining your options. If you have an emergency and can t safely wait to speak with your doctor, call 911 or go to the nearest emergency room. FirstHelp nurses won t be able to answer questions about the following: Your benefits and what is covered by your health care plan. Information on your claims. Pre-authorizations. If you have questions about your benefits or claims, please call the Member Services number listed on the back of your ID card. If you need authorization for a service, please call the appropriate number listed on the back of your ID card. Baltimore City Public Schools 2011 Health Care Options 13

16 My Account View real-time information on your claims and out of pocket costs online, whenever you need to with My Account. Simply log on to for real time information about your plan. Features of My Account n Find out who s covered on your policy and the effective date of your coverage. n Check your deductible and out-of-pocket costs for your current and previous plan year. n Review up to one year of medical claims total charges, benefits paid, and costs for a specific date range. Your Security Your log-in information is completely secure. Select your own User ID and Password, which you can change at any time. Our staff will never ask you for your password and to protect your security you ll be logged out automatically after 15 minutes of inactivity. Signing Up is Easy Visit click on First Time User Register Now and set up your User ID and Password. You ll just need information from your member ID card. Additional Tools Depending on your specific health plan you may have access to some services through My Account n View claims status and search claim history n Check your cost of a retail drug and find out if a generic is available n View out-of-pocket expenses n Update information about other healthcare coverage n a nurse and receive a secure, online response within 24 hours Some services may direct you to HCBO.com and you will be required to log in again. n s-view what s covered and eligibility information n View deductible, maximums and out-of-pocket costs n View and download your EOB n Send a message to member services n Request an ID card 14 Baltimore City Public Schools 2011 Health Care Options

17 How to Find a Doctor or Hospital In MD, D.C. and Northern Virginia It s easy to find the most up-to-date information on health care providers and facilities within the CareFirst BlueCross BlueShield service area of Maryland, Washington, D.C. and Northern Virginia. Here s how it works: 1. Go to Whether you need a doctor or a facility, can help you find what you re looking for based on your specific needs. We make it easy for you to find the doctors you need at The site is updated weekly, so you always have the most up-to-date information available. 2. Select Find a Doctor in the Solution Center. If you are a Preferred Provider Network (PPN) member, select Medical and then choose Preferred Provider Organization If you are a BlueChoice Point of Service (POS) member, select Medical and then choose CareFirst BlueChoice 3. From this screen you can choose a Primary Care, Specialist, OB/GYN or Mental Health Provider. Remember- all BlueChoice point of service members MUST select a Primary Care Physician (PCP). Please complete the form at the back of this booklet. Baltimore City Public Schools 2011 Health Care Options 15

18 What is a Transition of Care? In order to ensure continuity of treatment, CareFirst offers a special program called Transition of Care. If your request is approved, the Transition of Care program allows you or your covered dependent(s) to continue to receive care from a non-network physician for up to 90 days following the date of enrollment with benefits paid at the in-network level (i.e., minimal copayments and no calendar year deductible). Examples of medical conditions that may qualify for the Transition of Care program include: pregnancy (beyond 24 weeks gestation) bone fractures recent heart attack other acute trauma or surgery joint replacement newly diagnosed cancer If you think you may have a condition that qualifies for Transition of Care, please call the phone number on the back of your ID card. You may also find an application that needs to be completed by you and your physician at 16 Baltimore City Public Schools 2011 Health Care Options

19 Health & Wellness Discounts Alternative Therapies and Wellness Services Options Program The Options Program opens the door to discounts on a broad range of alternative therapies and wellness services. Options is a free program for CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, CareFirst) members. Because it s a discount program and not a benefit under your medical plan, you don t need to worry about claim forms, referrals or paperwork. To save, just show your health plan ID card and pay the provider s fee at the time of service. Want to know what services are available at discounted pricing? The chart on the next page is a directory of available services. For a more detailed listing, visit We re continually adding new services to the program so visit us online for the latest provider list and more information on each provider s discount or service. Blue365 Blue365 is a program through the Blue Cross and Blue Shield Association that gives you access to even more discounts at no additional cost. Discounts are available in the areas of health and wellness, family care, health focused financial services, and travel. Want to know more about what Blue365 has to offer? Go to and click on the Blue365 link at the bottom of the page for a list of vendors and resources available or call Member Services at the number on your ID card for more information. For details on the health and wellness discounts available to you, visit Baltimore City Public Schools 2011 Health Care Options 17

20 Health & Wellness Discounts Alternative Therapies and Wellness Services Options Program Directory Alternative Therapies & Wellness Eldercare Services Fitness Centers Hearing Care Laser Vision Correction & Contact Lenses* Medical IDs Weight Loss & Management Up to 30% discounts on chiropractic care, acupuncture, massage therapy, nutritional counseling, personal training, yoga, guided imagery, spa services and more. Healthways WholeHealth Networks, Inc. (800) Free referral services to help members find qualified providers through ElderCarelink. You can find information for elders and families including home health care, home support, assisted living, adult day care, long term care, nursing homes, and support groups for caregivers. ElderCarelink (866) Discounts on membership fees, initiation fees and more depending on which fitness network and location you choose. National Fitness Network (800) Free screenings, discounts on hearing aids and more. Beltone (800) TruHearing (877) Discounts on laser vision correction and 100% patient financing with approved credit. QualSight LASIK (877) TruVision (800) *Also offers discounts on mail-order contact lenses 22% discount on personalized medical ID bracelets and necklaces. American Medical ID (800) Nationally recognized weight loss plan discounts. Weight Watchers Online Jenny Craig (800) 96-JENNY carefirst.aspx The Options and Blue365 programs are not offered as an inducement to purchase a policy of insurance from CareFirst. CareFirst does not underwrite these programs because they are not insurance products. No benefits are paid by CareFirst under these programs. 18 Baltimore City Public Schools 2011 Health Care Options

21 Dear Employee: Please complete the Information Card below to select a PCP. Detach this informational record at the perforation below and return the Information Card (there is no postage due). This Information Card will assist us in processing your enrollment. By filling out this form, you select your own PCP. If you do not complete and return this form you will not have a PCP provider listed on your ID card. If you have questions, please do not hesitate to call Member Services Department at or Our representatives will be happy to assist you with any inquiry. When selecting your PCP, refer to the online directory at BALTIMORE CITY PUBLIC SCHOOLS BLUECHOICE POINT OF SERVICE PRIMARY CARE PHYSICIAN SELECTION CARD FOR PCP SELECTION ONLY TYPE OF NOTICE (Check One) NEW HIRE EMPLOYEE OPEN ENROLLMENT CHANGE EMPLOYMENT STATUS (Check One) ACTIVE COBRA COVERAGE TYPE (Check One) Individual Husband/Wife Parent/Child Family LAST NAME FIRST NAME M.I. STREET ADDRESS (INCLUDE APT. NO. OR P.O. BOX NO.) CITY STATE ZIP CODE HOME PHONE NUMBER BUSINESS PHONE NUMBER DATE OF BIRTH SEX ( ) ( ) / / MALE FEMALE SOCIAL SECURITY NUMBER PRIMARY CARE PHYSICIAN SELECTION (Refer to BlueChoice Directory)+ PCP # Existing yes patient? no After your BLUECHOICE coverage begins, will you or any eligible dependents be covered by any other insurance (including Medicare)? YES NO If yes, complete below: Insurance Co. Name: Policy Number: Insurance Co. Address: Insurance Effective Date: Policyholder Name: Policyholder Date of Birth: LIST ALL ELIGIBLE DEPENDENTS TO BE COVERED BY BLUECHOICE HEALTH PLAN Spouse or Domestic Partner Child Child Child Child Child LAST NAME FIRST NAME M.I. SOCIAL SECURITY NUMBER DATE OF BIRTH MO. DAY YR. / / / / / / / / / / / / M OR F Existing Patient Yes No Yes No Yes No Yes No Yes No Yes No NAME PRIMARY CARE PHYSICIAN SELECTION PCP# If any dependent s ADDRESS is different, please indicate dependent s full name and the correct address: If any dependent s LAST NAME is different, please explain relationship to subscriber: POLICYHOLDER (Subscriber) SIGNATURE Date CUT9195-1S (9/10) CareFirst BlueChoice, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Registered trademark of the Blue Cross and Blue Shield Association. Registered trademark of CareFirst of Maryland, Inc.

22 TAPE HERE BEFORE MAILING FOLD HERE BEFORE MAILING BUSINESS REPLY MAIL FIRST CLASS PERMIT NO. 57 Owings Mills, MD no postage necessary if mailed in the united states POSTAGE WILL BE PAID BY ADDRESSEE CareFirst State of Maryland BlueChoice Enrollment Mail CareFirst Stop BlueChoice OM Mail Stop Mill Run Circle Owings Mill Mills, Run MD Circle Owings Mills, MD Separate HERE BEFORE MAILING (Retain this for your records) TAPE here Return to: BEFORE MAILING PLEASE BE SURE TO: Sign the information card Date the information card These two pieces of information appear at the bottom of the information card.

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24 Did you know that the paper this book is printed on comes from an FSC certified paper company which means it gets pulp needed to produce paper from trees that come from sustainable forests on average, this industry plants 1.7 million trees daily. (from Sustainable Forestry Initiative) Mill Run Circle Owings Mills, MD CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Registered trademark of the Blue Cross and Blue Shield Association. Registered trademark of CareFirst of Maryland, Inc. BOK5297-1N (9/10)