More to feel good about. SM. BlueChoice and Personal Comp. Maryland

Transcription

1 More to feel good about. SM BlueChoice and Personal Comp Maryland

2 Table of Contents Overview 1 What to Consider When Choosing a Plan 2 BlueChoice HMO: How the Plan Works 4 BlueChoice HMO: Benefits At-a-Glance 6 Personal Comp: How the Plan Works 8 Personal Comp: Benefits At-a-Glance 9 Apply Today 10 CareEssentials 11 Dental and Vision Coverage Options 13 Privacy Practices 14 Additional Coverage Options 15 i BlueChoice HMO and Personal Comp

3 Welcome For the same price as many of the things you buy each day, you can have security and peace of mind with health care coverage from CareFirst BlueCross BlueShield (CareFirst) and CareFirst BlueChoice, Inc. (CareFirst BlueChoice). If you are looking for health care coverage with predictable copays and a regional network of doctors then you may want to consider the CareFirst BlueChoice HMO plan. Or, if you desire total flexibility and the freedom to choose any doctor or hospital, then the CareFirst Indemnity plan, Personal Comp, may be for you. Together, BlueChoice and Personal Comp offer 14 coverage options, allowing you to customize your coverage to meet your personal needs and budget. To help you learn more about the many benefits available from each plan, read on. Our BlueChoice HMO plan achieved an Excellent rating from the National Committee for Quality Assurance (NCQA). BlueChoice HMO and Personal Comp ii

4 Overview BlueChoice and Personal Comp BlueChoice BlueChoice is our HMO plan. As a CareFirst BlueChoice member, you and your family members each choose a Primary Care Physician (PCP) who will coordinate all of your health care needs. In most cases, appointments with specialists must be referred by your PCP. With BlueChoice, there are no medical deductibles to meet. And since BlueChoice doctors are part of a special network, you pay a predictable copay each time you visit. Since the same HMO plan can t meet the needs of everyone buying their own insurance, you can choose from one of three plan options each with different copay amounts, prescription drug plan benefits and out-of-pocket maximums. Personal Comp Personal Comp is our Indemnity plan. Personal Comp offers you the freedom to choose any doctor, specialist, or hospital you want, and no referrals. When you receive health care for covered services, CareFirst pays most of your bill while you pay the remainder. Personal Comp members are also responsible for a deductible, which is a set amount that you must pay out of pocket each year before CareFirst begins to pay. Personal Comp offers 11 deductible options. 1 BlueChoice HMO and Personal Comp

5 What to Consider When Choosing a Plan Selecting the right health plan doesn t have to be difficult. Here are five things to consider when determining which plan is right for you and your family. 1. Overall Cost Each health care plan requires you to pay a monthly premium your contribution to the cost of your insurance coverage for that year. In addition, you must pay the out-of-pocket costs associated with visiting doctors or hospitals, getting diagnostic tests, and purchasing prescription drugs. BlueChoice HMO traditionally offers a lower overall cost with no deductible or coinsurance, than other plans in exchange for your agreement to use only doctors and hospitals within the HMO network. Personal Comp members have more flexibility in choosing their doctors and hospitals and typically have lower premiums but do have a deductible and coinsurance. 2. Out-of-Pocket Costs Out-of-pocket costs are the amounts you pay in copays, coinsurance and deductibles each year. BlueChoice HMO allows you to pay a predictable copay each time you receive care, as long as you receive care from a doctor in the CareFirst BlueChoice network. n For example, if you choose the BlueChoice $15/$25 option, this means you will pay $15 each time for any visit to your PCP and $25 to a specialist who has been referred by your PCP. Personal Comp requires that you pay coinsurance, which is a percentage of the total cost of your visit. However, for preventive office visits, you pay a predictable copay. For most services, you must meet your deductible first. n For example, if you choose Personal Comp with $500 deductible, this means you are responsible for the first $500 of health-related costs (with the exception of preventive care). Once you meet that deductible, your plan will pay 80% of all covered expenses. You will be responsible for the remaining 20% of your coinsurance. 3. Flexible Physician Choices BlueChoice HMO requires you to select a PCP from the CareFirst BlueChoice HMO provider network. Your PCP will manage your care. In addition, you must select a network hospital for all non-emergency procedures. Personal Comp does not require you to select a PCP. You have the freedom to visit any doctor or hospital you choose, at any time you choose. And you can change your choice at any time. BlueChoice HMO and Personal Comp 2

6 What to Consider When Choosing a Plan 4. Need for Referrals BlueChoice HMO members are required to visit their PCP to obtain a referral, prior to visiting a specialist. If authorization from your PCP is not granted, your plan will not cover those expenses. It s important to note that you can self-refer to certain doctors without authorization from your PCP (including OB/ GYNs within the HMO network). Personal Comp plans do not require you to select a PCP or obtain referrals; you have the freedom to seek care whenever, and from whomever, you choose. 5. Simplicity If you want to keep your health care simple, an HMO may be your best option. BlueChoice HMO plans coordinate all your health care through your PCP. Your PCP will refer you to specialists, as needed, and will usually be able to recommend a doctor within the HMO network. Personal Comp plans offer you more flexibility in selecting your doctors; they allow you to participate more in your health care decisions without first discussing it with your primary care doctor. Which Plan is Best for Me? BlueChoice (HMO) Personal Comp (Indemnity) Premium Higher Lower Out-of-Pocket Cost Lower Higher Flexible Physician Choices Less Flexibility Complete Flexibility Need for Referrals Referrals Required No Referrals Required Simplicity PCP Manages Self-Managed 3 BlueChoice HMO and Personal Comp

7 BlueChoice How the Plan Works Your HMO Option As a BlueChoice member, you will receive health care services from a large regional network of physicians, specialists and hospitals, and have access to a wide range of benefits including preventive care and health education, routine physicals, outpatient surgery, pediatric care, gynecological care and much more. And, with BlueChoice, you don t have to work for a company or be a member of a group. Take a look at the choices BlueChoice can offer. Three different options so you can choose the plan to fit your budget. A preventive care package to keep you healthy, including well child care, immunizations, annual routine examinations, mammograms, PAP tests and prostate screenings. Predictable copays for primary care and specialist office visits and emergency room care, so that you don t need to worry whether or not you can afford treatment. 365 days of hospitalization for one facility copay per admission, then inpatient medical and surgical services are covered in full. Access to a large regional network of participating doctors and hospitals throughout Maryland, the District of Columbia and Northern Virginia. You can visit doctors where you live and work. Prescription drug coverage for predictable copays once you meet your deductible. Around the clock advice with a 24 hour per day, 7 day a week health care advice line, FirstHelp, staffed by registered nurses. Vision care benefits and special discounts. Optional dental benefits. BlueChoice HMO and Personal Comp 4

8 BlueChoice How the Plan Works Your Health Care Team You and your family members each choose a Primary Care Physician (PCP) from the CareFirst BlueChoice regional network to coordinate all of your health care needs. Your PCP oversees your routine and preventive care, administers your prescriptions, becomes familiar with your medical history and works closely with you to help make your medical decisions. When specialized care is needed, your PCP will recommend a specialist within the CareFirst BlueChoice network. Choose a PCP Refer to the enclosed provider directory to choose your PCP. For the most up-to-date listing, the CareFirst BlueChoice provider directory is available and updated every 15 days on the web at www. carefirst.com/doctor. You may also call your provider to see if he or she participates. Preventive Care BlueChoice strives to keep you healthy emphasizing prevention, early detection and early treatment. We work with you to help prevent illness by offering you annual routine examinations and office visits. We encourage you to seek care when it is first needed, rather than waiting. Well-Child Care BlueChoice wants to start your children on the road to good health with coverage for all childhood immunizations and checkups. We encourage parents to take advantage of this most important service. Women s Health / Men s Health BlueChoice provides women s and men s preventive health coverage such as routine mammograms and prostate screenings and PAP tests all at no charge to you. And women do not need a referral for gynecological care as long as care is provided by a CareFirst BlueChoice OB/GYN. Hospitalization Don t worry. If you receive care through your PCP, you are covered. We ll take care of you with hospitalization, including all physician charges for covered services, for one facility copay per admission. No Hassle Billing You pay no deductible and just a predictable, per visit, copayment. In addition, CareFirst BlueChoice provides direct reimbursement to your doctor, which means no hassles and no claims to file. 5 BlueChoice HMO and Personal Comp

9 BlueChoice Benefits At-a-Glance Services $10/$20 Option $15/$25 Option $20/$30 Option General Information Member Deductible $0 $0 $0 Out-of-Pocket Maximum n Individual n Individual & Child(ren)*/ Individual & Adult** n Family $2,000 $4,000 $3,000 $6,000 $3,600 $7,200 $6,000 $9,000 $11,000 Lifetime Maximum No lifetime maximum No lifetime maximum No lifetime maximum Preventive Services and Office Visits Well Child - Exams & Immunizations through age 17 $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist Adult Routine Preventive Health $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist Routine Gynecological Visits (No Charge for Pap Smear) Prostate Screening Visits (No Charge for PSA test) $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist Mammography Screenings No copay No copay No copay Allergy Testing and Treatment $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist Annual Routine Eye Exam at designated Davis Vision provider (optometrists or ophthalmologists). $10 $10 $10 Hearing Screening $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist Outpatient Medical and Surgical Services Physician Office Visit for Illness $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist Surgical Services-Professional $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist Surgical Services-Hospital or Other Facility $50 facility copayment, plus $10 PCP/$20 Specialist copay (if applicable) $50 facility copayment, plus $15 PCP/$25 Specialist copay (if applicable) $50 facility copayment, plus $20 PCP/$30 Specialist copay (if applicable) Diagnostic Procedures $10 PCP/$20 Specialist $15 PCP/$25 Specialist $20 PCP/$30 Specialist X-rays and Lab Tests at Plan Facilities Inpatient Hospital Services 365 Days Room and Board (Semi-Private Room) No copay No copay No copay $250 facility copay per admission $500 facility copay per admission Medical and Surgical Services No copay No copay No copay Prescription Drugs (Inpatient) No copay No copay No copay $700 facility copay per admission Please note that CareFirst BlueChoice also offers a health savings account-compatible plan, called BlueChoice HSA. If you would like more information about this plan then please call a Product Specialist at (410) or toll free at (800) BlueChoice HMO and Personal Comp 6

10 BlueChoice Benefits At-a-Glance (continued) Services $10/$20 Option $15/$25 Option $20/$30 Option Emergency or Urgent Care Plan-Affiliated Urgent Care Facility Hospital Emergency Room or Non-Plan Facility (waived if admitted) $20 $25 $30 $50 $50 $50 Ambulance No copay No copay No copay Prescription Drugs Annual deductible $50 $100 $150 Generic copay $10 $10 $10 Preferred Brand copay $25 $25 $25 Non-Preferred Brand copay $40 $40 $40 Annual drug benefit maximum $1,000 $1,000 $500 Maternity Services Prenatal and Postnatal Care PCP Specialist Inpatient Hospital Facility $10 per visit (up to $100 per pregnancy) $20 per visit (up to $200 per pregnancy) $250 facility copay per admission $15 per visit (up to $150 per pregnancy) $25 per visit (up to $250 per pregnancy) $500 facility copay per admission Delivery No copay No copay No copay $20 per visit (up to $200 per pregnancy) $30 per visit (up to $300 per pregnancy) $700 facility copay per admission Birthing Center $20 per visit $25 per visit $30 per visit Nursery Care No copay No copay No copay * Child means an unmarried, eligible child up to age 26. Eligibility requirements are defined in the CareFirst BlueChoice contract. ** Adult means the spouse or the domestic partner of the subscriber who resides with the subscriber and satisfies the eligibility requirements as defined in the CareFirst BlueChoice contract. 7 BlueChoice HMO and Personal Comp

11 Personal Comp How the Plan Works Your Indemnity Option Personal Comp makes health care more affordable by letting you decide how much of the plan s cost you want to share through deductibles and coinsurance. The higher the deductible you choose, the lower your premium rate. Your out-of-pocket maximum includes everything you pay toward your deductible and coinsurance payments. n Maximum flexibility choose from 11 benefit options, including two health savings account -compatible plans. n Freedom to choose any doctor or hospital no referrals to delay your visit to a specialist just make the appointment. n Preventive Care Package Predictable $10 or $30 copays for preventive services, and no deductible to meet! n Major medical coverage with up to a $1,000,000 policy maximum to protect you against the high cost of a lengthy illness. n Easy access to your benefits with the Blue Cross and Blue Shield BlueCard Program your direct link to healthcare services nationwide. Child-Only Coverage Personal Comp also offers child-only (ages 1-17) coverage for less than it costs to insure an adult. If your entire family doesn t need coverage, it s easy to protect your children. And, if you have more than one child, you can choose from a variety of deductibles for each child. How the Plan Works Personal Comp Plan Options You pay the deductible. (No deductible required for preventive care). Personal Comp pays 75% or 80% of the Allowed Benefit, after you meet the deductible, and you pay 25% or 20% up to your out-of-pocket maximum per year, minus the deductible you already paid. After you meet your out-of-pocket maximum, Personal Comp pays 100% of the allowed benefit for covered services for the rest of the year. Maximum Options Per Individual Your Deductible You Pay Your Out-of-Pocket Maximum $100 20% $1,000 $200 20% $2,000 $400 25% $2,000 $500 20% $2,000 $800 25% $2,000 $1,000 20% $2,500 $2,500 20% $4,000 $5,000 20% $6,000 $10,000 20% $10,000 $1,700* 20% $4,000 $2,500* 0% $2,500 *Health Savings Account-Compatible Plans BlueChoice HMO and Personal Comp 8

12 Personal Comp Benefits At-a-Glance A Health Plan that You Design As a member of Personal Comp, you can customize a health care program that s right for you and your budget. n You select your deductible. Generally, the higher the deductible, the lower your monthly premium. Unlike many other insurance companies, your deductible is applied toward your out-of-pocket maximum, limiting your health care costs. n Preventive care included for $10 per visit with no limit on physician office visits. And there is no deductible to meet. n Families never pay more than twice the individual deductible. Even if there are more than two family members on the policy. n You have complete freedom to choose your doctors and hospitals. Carry the card that s recognized and accepted across Maryland and nationwide. n Add dental and vision benefits to make your Personal Comp coverage even more valuable. Personal Comp Plan Options Benefit Covered You Pay 80%/20% Plan 75%/25% Plan Deductible Options (per individual)* $100, $200, $500, $1,000, $2,500, $5,000, $10,000 $400, $800 Well Child Care (up to age 18) 4 $10 $10 Adult Preventive Physical Exams 4 $10 $10 OB/GYN Preventive Care 4 $10 $10 Cancer Screening Visits (no charge for mammograms, pap tests and psas) 4 $10 $10 Three Lifetime EKGs (For members over 50 and if done during routine adult physical exam) 4 $10 $10 Once you meet the Out-of-Pocket Maximum 4 $0 $0 Physician Office Visits 4 20% (after deductible) 25% (after deductible) 365 Day Hospitalization 4 20% (after deductible) 25% (after deductible) Emergency Accident Care ($300 allowed benefit up front, when treatment begins within % (after deductible) 25% (after deductible) hours if deductible is $1,500 or less) Inpatient Physician Services 4 20% (after deductible) 25% (after deductible) Inpatient/Outpatient Surgery 4 20% (after deductible) 25% (after deductible) Maternity and Prenatal Care 4 20% (after deductible) 25% (after deductible) Diagnostic Tests and X-rays 4 20% (after deductible) 25% (after deductible) Physical Therapy/Chiropractic Services (up to 50 visits per year) 4 20% (after deductible) 25% (after deductible) Prescription Coverage ($500 annual benefit limit per person) 4 20% (after deductible) 25% (after deductible) Please note that CareFirst also offers two Personal Comp health savings account-compatible plans at the $1,700 and $2,500 deductible levels. If you are interested in Personal Comp HSA, please call a CareFirst Product Specialist at (410) , or toll free at (800) If you receive care from a provider that does not participate with CareFirst, you may be billed for the amount that is over the Allowed Benefit. * Individual & Child(ren), Individual & Adult, or Family coverage members never pay more than twice the individual deductible even if there are more than two family members on the policy. 9 BlueChoice HMO and Personal Comp

13 Apply Today for BlueChoice or Personal Comp Just Follow These Steps 1. Choose a coverage type. You can select: n Individual n Individual and Child(ren)* n Individual and Adult** n Family [Two eligible adults and eligible dependent(s)]*** * Child means an unmarried, eligible child up to age 26. Eligibility requirements are defined in the CareFirst BlueChoice or Personal Comp contract. ** Adult means the spouse or domestic partner of the Subscriber/Policyholder who resides with the Subscriber/ Policyholder and satisfies the eligibility requirements defined in the CareFirst BlueChoice or Personal Comp contract. *** Family membership provides coverage for two eligible adults and eligible dependent(s). 2. Determine the plan that best fits your needs. The enclose rate charts, coverage type and age shows your monthly premium. For BlueChoice n Our $10/$20 option: you pay a lower copayment as low as $10 per office visit but pay a higher monthly premium. n Our $15/$25 option: you pay a mid-range copayment and a mid-range premium. n Our $20/$30 option: you pay a higher copayment for office visits but pay a lower monthly premium. For Personal Comp Choose from 11 deductible levels (including two health savings account-compatible options). 3. Locate the application packet in the envelope marked, To Apply for CareFirst BlueChoice HMO Plan, Open Here or, To Apply for Personal Comp Indemnity Plan, Open Here. Be sure to complete and sign your application. If you are appying for Personal Comp make sure you check yes in the Vision benefit selection area if you would like the additional coverage. 4. Three ways to apply! n Apply through your broker, or n Apply online and be approved in as little as 24 hours at or n Mail your application in the enclosed envelope to: CareFirst BlueCross BlueShield Individual Market Division / RR Mill Run Circle Owings Mills, MD Send no money when you apply. We ll begin processing your application right away! Once you have submitted your application, you can call the Application Status Hotline toll free at (800) for a status report on your application. If you have questions, please call our Product Specialists at (410) or toll free at (800) , Monday-Friday 8 a.m. - 5 p.m. or, visit the CareFirst Web site at BlueChoice HMO and Personal Comp 10

14 CareEssentials Taking Control of Your Health As a member, you are encouraged to take advantage of the CareEssentials program at no additional charge. Whether you re looking for health and wellness tips or support to manage a health condition you ll find it with CareEssentials. Prevention Health Coaches Work with a health coach to set and reach achievable goals with our Healthy Lifestyle Coaching program. If your MyHealthProfile report shows you could have a future health risk, you ll be invited to participate in our Healthy Lifestyle Coaching program. If you have any questions about the program, please call (866) MyHealthProfile Get a personalized, confidential health report when you enroll in a BlueChoice or Personal Comp health care plan. You ll receive directions for accessing MyHealthProfile, a health questionnaire, through the mail. Once you answer questions about your health, you ll receive a report that will alert you to any possible health risks and provide recommendations on how to stay healthy. If you have any questions about MyHealthProfile or have technical difficulties accessing the web site, contact a health support representative at (866) and press 1. Online Lifestyle Programs Based on the results of your MyHealthProfile report, you may qualify for programs that can help you: n Lose weight n Keep a healthy diet n Maintain an exercise routine n Quit smoking n Manage stress n Prevent depression n Comply with your medications These programs are customized for you and can help you achieve a healthier lifestyle. You can also read personalized reports, complete interactive exercises and access external resources such as tracking tools, testimonials and quizzes. FirstHelp Any time, 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. Simply call (800) and a registered nurse will ask about your symptoms and help you decide on the best source of care. Options Discount Program As a CareFirst member, you have access to discounts on alternative therapies and health and wellness programs such as fitness centers, acupuncture, massage, chiropractic care, nutritional counseling, laser vision correction, and more! Visit My Care First Website Take an active role in managing your health and visit My Care First at Find nearly 300 interactive health-related tools, a multi-media section with more than 400 podcasts, and recipes to search by food group/dietary restrictions. Plus, there are videos and tutorials on chronic diseases and an encyclopedia with information on more than 3,000 conditions. Vitality Magazine Our member magazine has the tools to help you achieve a healthier lifestyle. Vitality provides you with updates to your health care plan and a variety of health and wellness topics, including food and nutrition, physical fitness and preventive health. 11 BlueChoice HMO and Personal Comp

15 CareEssentials Taking Control of Your Health Health News Sign up for our monthly electronic member newsletter to receive health-related articles and recipes via . Visit to subscribe for information on: n Making healthy choices. n Adding physical activity to your day. n Preparing nutritious and delicious recipes. n Getting the best health care. n Managing chronic conditions. Utilization Management Coordinating Your Care If you need to be hospitalized or require therapy, your doctor will work with our Utilization Management team to ensure you receive the right care, in the right place, at the right time. And if you re hospitalized, a Utilization Management nurse will review your information and assist with discharge planning or approving additional inpatient hospital days, if necessary. Disease Management Manage Your Condition You have many things to consider when you have a chronic condition, which is why your member benefits include the Disease Management program. A confidential and voluntary program offering support and health information from highly trained nurses will help you manage your overall health. Care Managers are available to help you manage: n Heart Failure n Coronary Artery Disease n Osteoporosis How It Works 1. Enroll by calling (800) You ll receive a welcome letter and phone call from your Care Manager, who will keep your doctor informed of your progress in the program. Your Care Manager supports your relationship with your physician but doesn t replace it. 3. Throughout the program, you may receive: n Periodic calls from your Care Manager to support your self-care efforts. n Reminders to schedule important appointments. n Toll-free access 24-hours a day. n Newsletters and educational materials. Case Management If you re faced with a serious diagnosis or condition, we have a Case Management program to help you navigate through the health care system and provide support. 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 re doing. n Answer any of your questions. n Suggest available community resources. The program is voluntary and confidential. To enroll or to find out more information, call (888) n Asthma n Diabetes BlueChoice HMO and Personal Comp 12

16 Dental and Vision Coverage Options Dental As a BlueChoice or Personal Comp member, you have the option of adding dental coverage to your medical plan, making your medical plan even more valuable. You cannot be turned down for this product. When you select dental, you get coverage for: n Preventive care n Cleanings n X-rays n Fillings n Orthodontics Dental savings are guaranteed as long as you select a general dentist from a network of participating providers to coordinate all your dental care needs. There are no claim forms to file with this benefit. You simply present your member ID card at the time of service and pay a predictable copayment for routine and major dental services. If requested, a dental information kit will be sent to you separately. For questions regarding dental coverage or to inquire about participating providers, please contact a product specialist at (800) Vision As a BlueChoice HMO member, eye care benefits are part of your medical plan, through our network administrator, Davis Vision, Inc. For annual eye examinations, just call and make an appointment with one of the participating providers and pay the $10 copay at the time of service. As a Personal Comp member, you have the option of adding eye care benefits to your medical plan through our network administrator, Davis Vision, Inc. Benefits include annual eye examinations at participating providers for a $10 co-pay at the time of service. Vision benefits include discounts of approximately 30% off of eyeglass lenses or contact lenses. For medical eye care please follow your normal medical procedures. Your vision benefits are not available until you are approved for medical coverage. Once you have been approved for coverage, you will be provided with more specific information about your vision program. To qualify for benefits, you must select the same type of coverage as you selected for your medical plan coverage (Individual, Individual and Child(ren), Individual and Adult, Family). To locate a vision provider, contact Davis Vision, Inc at (800) or visit Type of Vision Coverage: You Pay (monthly): Individual $2.00 Individual and Child(ren) $4.00 Individual and Adult $4.00 Family $ BlueChoice HMO and Personal Comp

17 Privacy Practices Our Commitment to Our Members When you apply for any type of insurance, you disclose information about yourself and/or members of your family. The collection, use and disclosure of this information are regulated by law. Safeguarding your personal information is something that we take very seriously at CareFirst. CareFirst is providing this notice to inform you of what we do with the information you provide to us. Categories of Personal Information We May Collect We may collect personal, financial and medical information about you from various sources, including: n Information you provide on applications or other forms, such as your name, address, social security number, salary, age and gender. n Information pertaining to your relationship with CareFirst, its affiliates or others, such as your policy coverage, premiums and claims payment history. n Information (as described in preceding paragraphs) that we obtain from any of our affiliates. n Information that we receive about you from other sources, such as your employer, your provider and other third parties. How Your Information Is Used We use the information we collect about you in connection with underwriting or administration of an insurance policy or claim, or for other purposes allowed by law. At no time do we disclose your personal, financial and medical information to anyone outside of CareFirst unless we have proper authorization from you or we are permitted or required to do so by law. We maintain physical, electronic and procedural safeguards in accordance with federal and state standards that protect your information. In addition, we limit access to your personal, financial and medical information to those CareFirst employees, brokers, benefit plan administrators, consultants, business partners, providers and agents who need to know this information to conduct CareFirst business or to provide products or services to you. Disclosure of Your Information In order to protect your privacy, affiliated and nonaffiliated third parties of CareFirst are subject to strict confidentiality laws. Affiliated entities are companies that are a part of the CareFirst corporate family and include health maintenance organizations, third party administrators, health insurers, long-term care insurers and insurance agencies. In certain situations, related to our insurance transactions involving you, we disclose your personal, financial and medical information to a nonaffiliated third party that assists us in providing services to you. When we disclose information to these critical business partners, we require these business partners to agree to safeguard your personal, financial and medical information and to use the information only for the intended purpose, and to abide by the applicable law. The information CareFirst provides to these business partners can only be used to provide services we have asked them to perform for us or for you and/or your benefit plan. Changes in Our Privacy Policy CareFirst periodically reviews its policies and reserves the right to change them. If we change the substance of our privacy policy, we will continue our commitment to keep your personal, financial and medical information secure it is our highest priority. Even if you are no longer a CareFirst customer, our privacy policy will continue to apply to your records. You can always review our current privacy policy online at BlueChoice HMO and Personal Comp 14

18 Additional Coverage Options We can help you sort through the many options available to find the plan that makes the most sense for your financial situation and health needs. These plans require medical underwriting. Did you know that we offer special plans for children over one year old? Enrolling your child in a separate plan may be a less expensive option than family coverage. Or perhaps you and your spouse have very different health conditions or a large age gap, you may find that it is less expensive to have separate plans. Your broker or our Product Specialists can help. You may request additional information on any of these plans at (410) or toll free at (800) , Monday-Friday 8 a.m. 5 p.m. Or, visit the CareFirst Web site at individual. HMO (Health Maintenance Organization) BlueChoice-Saver and BlueChoice HSA plans offer a partnered approach to health care. You and your family select a Primary Care Physician (PCP). The PCP coordinates most of your health care needs. Plan choices include high-deductible options to lower your premiums and health savings account-compatible plans that offer tax-savings benefits. PPO (Preferred Provider Organization) BluePreferred, BluePreferred-Saver and BluePreferred HSA plans offer you the freedom to see any doctor. However, you will notice that costs will be less if you use doctors within CareFirst s Preferred Provider Network. Plan options include high-deductible choices to lower your premiums and health savings account compatible plans that offer tax-savings benefits. Traditional Personal Comp HSA offers you the same great benefits as our Personal Comp plan. Select from two health savings account-compatible plans that offer tax-savings benefits. Medicare Supplemental MediGap-65 offers you traditional coverage designed to enhance your Medicare plan. For more information about this plan please call our Product Specialist toll-free at (800) CareFirst BlueCross BlueShield is the business name of Group Hospitalization and Medical Services, Inc. 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. 15 BlueChoice HMO and Personal Comp

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20 Policy Form Numbers: CFMI/DB/PERS COMP (5/07) MD-CC-UW EOC (3/01) as amended 3221 (1/97) as amended (1/96) as amended 3097, 3149, 3098, 3099 as amended Mill Run Circle Owings Mills, MD CareFirst BlueCross BlueShield is the business name of Group Hospitalization and Medical Services, Inc. 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. BRC6930-1N (5/10)