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Medical, Prescription, Vision Coverage

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 Medical Insurance, Prescription Coverage & Vision Coverage are bundled together.    There are 2-options offered by CareFirst to choose from.

 

  •  CareFirst BlueChoice HMO Open Access Plan
    • With the BlueChoice HMO, your primary care provider (PCP) provides routine care and coordinates specialty care.  This plan allows also allows one to visit specialists directly - no referrals needed.
      • Some highlights include:
        • Network of 40,000 CareFirst BlueChoice providers
        • After-hours care (24-hr nurse advice line, video visits, urgent care centers, etc.)
        • $0 cost for comprehensive preventative health
        • Away from Home Care Program - access to benefits when out of area for at least 90 days* (set up by contacting CareFirst)
        • Emergency or Urgent Care Coverage when outside CareFirst BlueCross BlueSheild's service area (Maryland, Washington, D.C. and Northern Virginia)

 

  • CareFirst BlueChoice Advantage
    • BlueChoice Advantage offers in- and out-of-network coverage to help control out-of-pocket costs.  With this plan, there is no referral required to see a specialist.
      • Some highlights include:
        • $0 cost for comprehensive preventative health care visits
        • Flexibility to choose any provider you want
        • Choose from CareFirst PPO provider, specialists, and hospitals in Maryland, Washington, D.C. and Northern Virginia
        • If out of the CareFirst local service area, you have access to providers in all 50-states 

 

Prescription Coverage is offered through CareFirst with CVS/CareMark

  • Through the prescription program you have access to  more than 69,000 participating pharmacies, 5,000 covered drugs through CareFirst Formulary 2, and a mail-order pharmacy program.
  • The 3-Tier copayment structure:
    • $5.00 for Generics
    • $25.00 for Brand Name Preferred Medications
    • $50.00 for Brand Name Non-Preferred Medications
      • Non-Preferred Brand Name Medications have a Generic (more cost-effective) equivalent available.  Preferred Brand Name Medications do not.
  •  Maintenance medications purchased as a 90-day supply through mail-order, or at CVS pharmacies will only pay 2 co-payments rather than 3 co-payments.

 

Vision Coverage is offered through CareFirst's BlueVision Plus Plan with Davis Vision 

  • The CareFirst BlueVision Plus program provides coverage for routine eye exams and preventive care, plus the freedom of choice to select any licensed vision care provider in the U.S.
    • Some of the highlights include:
      • Complete freedom to choose any ophthalmologist, optometrist or optician.
      • No claims to file if using a participating provider.
      • Coverage for comprehensive vision exams.
      • Coverage for lenses and frames or contacts