Enrollment Guide WASHINGTON COUNTY PUBLIC SCHOOLS 2014 Washington County Public Schools Enrollment Guide C1
Table of Contents Welcome... 1 Exclusive Provider Organization (EPO)... 2 Preferred Provider Organization... 4 Maryland Point of Service... 6 Patient-Centered Medical Home... 9 Find a Doctor, Hospital or Urgent Care.... 11 Summary of Benefits... 12 Health + Wellness... 14 My Account... 16
Welcome Welcome to your plan for healthy living From preventive services to maintain your health, to our extensive network of providers and resources, CareFirst BlueCross BlueShield (CareFirst) is there when you need care. We will work together to help you get well, stay well and achieve any wellness goals you have in mind. FREE My Account mobile app We know that health insurance is one of the most important decisions you make for you and your family and we thank you for choosing CareFirst. This guide will help you understand your plan benefits and all the services available to you as a CareFirst member. Please keep and refer to this guide while you are enrolled in this plan. How your plan works Find out how your health plan works and how you can access the highest level of coverage. Get our free app from your favorite app store by searching for CareFirst. Health care information is in the palm of your hand with CareFirst s new mobile app that allows you to manage your care, access claims information, view your ID cards and find a doctor or urgent care center any time of the day or night from your smartphones or tablets. What s covered See how your benefits are paid, including any deductibles, copayments or coinsurance amounts that may apply to your plan. Getting the most out of your plan Take advantage of the added features you have as a CareFirst member: Wellness discount program offering discounts on fitness gear, gym memberships, healthy eating options and more. Online access to quickly find a doctor or search for benefits and claims. My Care First wellness website with health calculators, tracking tools and podcast videos on specific health topics. Vitality magazine with healthy recipes, preventive health care tips, and articles on nutrition, physical fitness, and stress management. Washington County Public Schools Enrollment Guide 1
Exclusive Provider Organization (EPO) With the EPO, you have the strength of CareFirst Blue Cross and Blue Shield Plan credentialed network providers, but also a wide range of benefits, including preventive benefits which can help you treat conditions before they become serious. Some of these benefits include: child immunization diagnostic tests doctor s office visits emergency care home care and hospice care immunizations inpatient hospital care maternity care mammography screenings routine adult physicals routine gynecological visits speech, occupational, and physical therapy surgery well-child care X-rays Service that counts You can talk to our knowledgeable Customer Service representatives who will be happy to answer any questions you may have about claims and benefits. Peace of mind You can rest easy knowing that you have the most widely recognized and accepted insurance card in the country. When you need care Once you have enrolled in the EPO, and your benefits are effective, you are ready to use your health insurance plan. Whether you need routine care or specialty care, you will need to select a PCP in order to receive coverage. 2 Washington County Public Schools Enrollment Guide
Exclusive Provider Organization (EPO) Your benefits Step 1: Meet your deductible Your plan requires you to meet a deductible, for certain services. You will be responsible for the entire cost of your medical care up to the amount of your deductible for these services. Once your deductible is satisfied, your EPO coverage will become available to you. Some services, like office visits, have a copay instead of a deductible. You can refer to the chart on pages 12 13 for further details. Step 2: Your EPO plan will start to pay for services After you satisfy your deductible, your EPO plan will start to pay for covered services. You will have to pay coinsurance or copays, where applicable, when you receive care. Step 3: Your out-of-pocket maximum Your out-of-pocket maximum is the maximum amount you will pay during your benefit period. Should you reach your out-of-pocket maximum, CareFirst will then pay 100% of the allowed benefit for most covered services for the remainder of the benefit period. Any amount you pay toward your deductible, coinsurance and copays will count toward your out-of-pocket maximum. You may choose a doctor who specializes in family practice, general practice, pediatrics or internal medicine as your PCP. Your entire family may select the same doctor, or each member may choose a different doctor, based on each person s age or medical needs. To select your PCP, please call CareFirst customer service at 800-628-8549 or call the local Hagerstown district office at 301-733-5995. To ensure that you have the most current provider information, we encourage you to visit our online provider directory at www.carefirst.com. Referrals to specialists Your PCP will coordinate your medical care and provide treatment for a variety of medical conditions. Generally, your PCP will need to see you for a proper evaluation before issuing a written referral. You and your PCP can work together to select a specialist. CareFirst BlueCross BlueShield provides your benefits on a contract year basis. Your deductible period runs for a consecutive 12 months from July 1st through June 30 each year. Your primary care physician Establishing a relationship with one doctor is the best way for you to receive consistent, quality health care; therefore, you must select a PCP at the time of your enrollment into the EPO plan. It is important that you select a PCP. If you have not selected a PCP for yourself or a covered family member, all covered services will be denied. Your PCP will: Provide basic medical care treating illness and providing preventive care. Prescribe any medications that you may require. Maintain your medical history. Work with you to determine when you should see a specialist, assist in the selection of a specialist, and provide you with a written referral. Washington County Public Schools Enrollment Guide 3
Preferred Provider Organization A Referral-Free Go Anywhere Health Plan Designed for today s health conscious and busy families, the Preferred Provider Organization (PPO) plan offers one less thing to worry about during your busy day. Your PPO 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 provider (PCP) or obtaining a PCP referral for specialist care. Benefits of PPO Access to our network of more than 23,000 doctors, specialists and hospitals in Maryland, Washington, D.C. and Northern Virginia. No primary care provider required, and no referrals to see a specialist. Take your health care benefits with you across the country and around the world. Receive coverage for preventive health care visits at no cost. Avoid balance billing when you receive care from a preferred provider. Enjoy the freedom to visit providers outside of the PPO 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 PPO plan offers depends on whether you see a provider in the PPO network (preferred provider). You will always receive a higher level of benefits when you visit a preferred provider. However, the choice is entirely yours. That s the advantage of a PPO plan. In-network benefits provide a higher level of coverage. This means you have lower out-of-pocket costs when you choose a PPO network provider. You have the freedom to select any provider that participates with a Blue Cross and Blue Shield PPO plan across the country and receive benefits at the in-network level. No referrals. No PCPs. Coverage everywhere. 4 Washington County Public Schools Enrollment Guide
Preferred Provider Organization (PPO) A Referral-Free Go Anywhere Health 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 PPO network (non-preferred provider), you may have to: Pay the provider s actual charge at the time you receive care. File a claim for reimbursement. 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) PREAUTH. Deductible and out-of-pocket limit After you satisfy your deductible (if applicable), CareFirst pays a percentage of the allowed benefit for covered services. You receive a higher level of reimbursement when you use a Preferred Provider. If you obtain care from a non-preferred Provider, but one who participates with CareFirst, you will be responsible for any applicable deductible, copayment and/or coinsurance amount up to the allowed benefit. However, if the provider is not a Preferred or Participating Provider, in addition to the copayment and/or coinsurance, you will also be responsible for the difference between the allowed benefit and the provider s billed charges. Once you reach your out-of-pocket limit, CareFirst pays 100% of the applicable allowed benefit for most covered services for the remainder of the calendar year. Expenses which count toward your out-of-pocket limit include the annual deductible, copay and coinsurance amounts. CareFirst BlueCross BlueShield provides your benefits on a contract year basis. Your deductible period runs for a consecutive 12 months from July 1st through June 30 each year. Out-of-area coverage You have the freedom to take your health care benefits with you across the country and around the world. BlueCard PPO, 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 your health plan s service area. The BlueCard program includes more than 6,100 hospitals and 600,000 other health care providers nationally. In-Network Option 1 Preferred Provider Network Option 2 Participating Provider Out-of-Network You benefit from: You benefit from: You benefit from: acceptance of CareFirst BlueCross BlueShield card nationwide direct reimbursement to provider no balance billing reduced out-of-pocket expenses access to the PPO Provider Directory deductible and coinsurance acceptance of CareFirst BlueCross BlueShield card nationwide direct reimbursement to provider no balance billing Option 3 Non-Participating Provider the ability to choose any doctor You are responsible for: You are responsible for: You are responsible for: copays and coinsurance in-network deductibles, where applicable deductible and coinsurance direct payment to provider balance-billed amount up to the provider s charge filing your claim Washington County Public Schools Enrollment Guide 5
Maryland Point of Service Maryland Point of Service aims to keep you healthy by emphasizing prevention, early detection and early treatment. That s one of the main advantages of your MPOS coverage. We work with you to help prevent illness and we encourage you to seek care when it is needed, rather than waiting. You can select your doctor from a network of physicians, specialists and hospitals located throughout Maryland, Washington, D.C., and Northern Virginia so now you can visit a doctor where you live, where you work or anywhere in between. Designed for today s health conscious and busy families, Maryland Point of Service offers one less thing to worry about during your busy day. As a member of CareFirst BlueCross BlueShield (CareFirst), you ll enjoy the protection of one of the area s leading health care insurers. CareFirst has been serving your neighbors for almost 70 years, so when your family s health is at stake, shouldn t you choose Blue? Benefits and Services Flexibility Maryland Point of Service (MPOS) offers two levels of benefits in one health plan. When you need medical care, you have the flexibility to see your primary care physician (PCP) or you may go out of the network and see any doctor you choose. Your choice determines whether benefits will be paid at the in-network or out-ofnetwork level. Coordinated care with the freedom to choose. Maternity and well-child care MPOS provides coverage for prenatal and postnatal visits as well as childhood immunizations and check-ups. We aim to start your children on the road to good health before they are born. Our Great Beginnings program for expectant mothers is designed to complement the prenatal care and education you receive from your doctor. When you enroll in Great Beginnings you will receive information related to your condition and your baby s development. A Great Beginnings nurse will contact you 6 Washington County Public Schools Enrollment Guide
Maryland Point of Service during each trimester to see how you are feeling and to answer your questions. We believe in giving baby and mother a healthy start, and want to encourage mothers to take advantage of these important services. Women s health / men s health In addition, Maryland Point of Service provides women s health coverage, such as PAP tests, and men s health coverage, which includes routine prostate screenings. Predictable copays When your PCP coordinates your care, you can rely on predictable copays and coinsurance for your primary care and specialist office visits and emergency room care, so there is no need to worry about unexpected doctor bills. Large network Doctors, specialists and hospitals are located throughout Maryland, Washington, D.C., and Northern Virginia. No hassle billing Maryland Point of Service requires little paperwork when your PCP coordinates your care. In addition, MPOS provides direct reimbursement to your doctor, which means no hassles and no claims to file. Out-of-area coverage When you require health care while away from home, you will be covered with your in-network benefits for emergency care. Emergency and urgent care Each MPOS doctor provides 24-hour-a-day availability so you are never out of reach of your PCP. If the condition is serious, but not life threatening, call your PCP and he or she will give you instructions on what to do next. Your doctor may refer you to an urgent care center. Urgent care centers are walk-in medical facilities equipped to handle minor emergencies. Urgent care centers allow you to be seen more quickly than emergency rooms and most have evening and weekend hours. A list of participating urgent care centers can be found in the provider directory or at www.carefirst.com. In a life-threatening emergency, such as chest pain, unconsciousness or severe bleeding, we encourage you to go immediately to the nearest emergency room or call 911. Mental health care and substance abuse treatment Magellan Behavioral Health Services provides and coordinates all needed mental health care. Just call their toll free number for a referral and authorization if you need psychiatric or substance abuse treatment. Your primary care physician Establishing a relationship with one doctor is the best way for you to receive consistent, quality health care; therefore, you must select a PCP at the time of your enrollment into MPOS. It is important that you select a PCP. If you have not selected a PCP for yourself or a covered family member, all covered services will be denied. Your PCP will: Provide basic medical care treating illness and providing preventive care. Prescribe any medications that you may require. Maintain your medical history. Work with you to determine when you should see a specialist, assist in the selection of a specialist, and provide you with a written referral. You may choose a doctor who specializes in family practice, general practice, pediatrics or internal medicine as your PCP. Your entire family may select the same doctor, or each member may choose a different doctor, based on each person s age or medical needs. To select your PCP, please call CareFirst customer service at 800-628-8549 or call the local Hagerstown district office at 301-733-5995. To ensure that you have the most current provider information, we encourage you to visit our online provider directory at www.carefirst.com. Referrals to specialists Your PCP will coordinate your medical care and provide treatment for a variety of medical conditions. Generally, your PCP will need to see you for a proper evaluation before issuing a written referral. You and your PCP can work together to select a specialist. Washington County Public Schools Enrollment Guide 7
Maryland Point of Service CareFirst BlueCross BlueShield provides your benefits on a contract year basis. Your deductible period runs for a consecutive 12 months from July 1st through June 30 each year. When you need care Case Management This voluntary program works with patients who have serious illnesses, chronic conditions and complex health care needs. It helps patients receive needed care by working with the patient, family and medical team to develop the best treatment plan. Case managers are medical review nurses who can help patients make the best use of their coverage, and can even authorize special benefits or programs when it s cost effective and in the best interest of the patient. Outpatient pretreatment certification Before receiving home care, hospice care, habilitative services, mental health care, substance abuse treatment, outpatient private duty nursing care, artificial insemination, in-vitro fertilization and certain surgical procedures; CareFirst must approve a plan of treatment. For physical, occupational or speech therapy, your provider is required to submit a plan of treatment by the tenth visit. Preconception and prenatal education program If you are trying to get pregnant or if you are already pregnant, free consultations with a health specialist are available. This information, advice and encouragement can help you prepare for pregnancy, your baby s birth and parenthood. Hospital precertification and review program Anytime you face hospitalization, the Hospital Precertification and Review Program works with your provider to determine the most appropriate place for your procedures and recovery. 8 Washington County Public Schools Enrollment Guide
Patient-Centered Medical Home Focusing on You and Your Health Whether you re trying to get healthy or stay healthy, you need the best care available. That s why the CareFirst BlueCross BlueShield family of health plans has created a program to improve health care quality and help slow rising health care costs over time. Our Patient-Centered Medical Home (PCMH) program focuses on the relationship between you and your primary care provider (PCP) whether a physician or nurse practitioner (NP). It s designed to provide your PCP 1 with a more complete view of your health needs, as well as the care you re receiving from other providers. As the leader of your health care team, your PCP will be able to use this information to better manage and coordinate your care, a key to better health. Treating your overall health Whether you see your PCP for preventive care, or you need more care, your PCP is expected to: Coordinate your care with all your health care providers, including specialists, labs, pharmacies, and mental health facilities to help you get access to, and receive, the most appropriate care available in the most affordable settings. Identify and address any impact the care you receive for one health issue may have on another. Review all of your medications and possible drug interactions with you. Review your health records for duplicate tests or services already ordered or performed by another provider. Why a PCP is important to your health By visiting your PCP for routine visits as recommended, you can build a relationship, and your PCP will get to know you and your medical history. A PCP is concerned with your overall health. If you have an urgent health issue, having a PCP who knows your health history often makes it easier and faster to get the care you need. Your PCP can sometimes provide advice over the phone or fit you in for a visit. That helps you avoid long lines and expensive charges at the emergency room. When you visit your PCP for screenings and preventive services, he or she can detect health concerns in the early stages, when they are easier and less costly to treat. 1 The doctors and other medical providers, who provide your care, are independent providers making their own medical determinations and are not employed by either CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc. Washington County Public Schools Enrollment Guide 9
Patient-Centered Medical Home Focusing on You and Your Health If you have a chronic condition, or are at risk for one, your PCP may: Create a Care Plan based on your health needs with specific follow-up activities to help you manage your health. Provide access to a care coordinator, who is a registered nurse (RN), so you have the support you need, answers to your questions and information about your care. Extra care for certain health issues When you participate in PCMH, your PCP will take specific steps to coordinate and manage your care. If you have certain health issues, your PCP will create an online record of your health needs with specific follow-up activities. Your care coordinator is expected to: Assist your PCP by coordinating your care and answering your questions. Follow up with you to make sure you re not having problems following your treatment plan. For example, if you have diabetes, the care coordinator can help you take steps to better understand and control your diabetes. Assist you in obtaining services and equipment necessary to manage your health condition. It s your choice PCMH is a voluntary program. When you participate: You pay no additional premium. There is no change in your benefits. There is no change to your health plan requirements. You can opt-out at any time without penalty and without changing your PCP and/or NP. How do I get started? Simply sign the Election to Participate form and return it to your PCP. You can get the form from your PCP, or you can download it from the Forms section at www.carefirst.com/memberpcmh. By signing the election form, you agree to give your PCP access to your health information on file with CareFirst. This includes data from claims and notes from any CareFirst programs in which you have participated. 10 Washington County Public Schools Enrollment Guide
Find a Doctor, Hospital or Urgent Care www.carefirst.com/doctor It s easy to find the most up-to-date information on health care providers and facilities who participate with CareFirst BlueCross BlueShield (CareFirst). Whether you need a doctor or a facility, www.carefirst.com 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 www.carefirst.com. The site is updated weekly, so you always have the most up-to-date information available. The most up-to-date information Go to www.carefirst.com/doctor. From here you can: Find a doctor or provider in your plan. Search for a doctor by name. Select a Primary Care Physician. Click Find Providers tab on www.carefirst.com to: Learn more about our Directory. Change your PCP. Research a Doctor or Hospital. Learn about Specialists. Washington County Public Schools Enrollment Guide 11
Summary of Benefits Washington County Public Schools SERVICES ANNUAL DEDUCTIBLE Individual Individual & Child Individual & Adult Family ANNUAL OUT-OF-POCKET LIMIT Individual Individual & Child Individual & Adult Family $100 $1,000 $2,000 $2,000 $2,000 EPO In-Network You Pay Maryland Point of Services (MPOS) $100 In-Network You Pay Out-of-Network You Pay $400 $400 $400 $1,000 $2,000 $2,000 $2,000 $100 LIFETIME MAXIMUM None None None PREVENTIVE SERVICES Well-Child Care 0-17 years Adult Physical Examination (1 per benefit period) Routine GYN Visits (1 per benefit period) Preferred Provider Organization (PPO) In-Network You Pay $400 $400 $400 $1,000 $2,000 $2,000 $2,000 No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit Out-of-Network You Pay Mammograms 30%, Cancer Screening (Pap Test, Prostate and Colorectal) OFFICE VISITS, LABS AND TESTING 30%, Office Visits for Illness $20 per visit $20 per visit Deductible, then 30% Diagnostic Services X-ray and Lab Tests Allergy Testing Allergy Shots Outpatient Physical, Speech and Occupational Therapy in office (limited to 60 visits/benefit period combined) Deductible, then 30% Deductible, then 30% $20 per visit $20 per visit Deductible, then 30% Outpatient Chiropractic $20 per visit $20 per visit Deductible, then 30% EMERGENCY CARE AND URGENT CARE $20 per visit 30%, 30%, 30%, 30%, 30%, $20 per visit 30%, $20 per visit 30%, Physician s Office $20 per visit $20 per visit $20 per visit $20 per visit $20 per visit Urgent Care Center $20 per visit $20 per visit $20 per visit $20 per visit $20 per visit Hospital Emergency Room Ambulance (if medically necessary) $20 Physician; $50 Facility $20 Physician; $50 Facility $20 Physician; $50 Facility $20 Physician; $50 Facility $20 Physician; $50 Facility * No copayments or coinsurance. Members are liable for the difference between CareFirst s allowed benefit and the providers charge for services rendered by a non-participating provider. 12 Washington County Public Schools Enrollment Guide
Summary of Benefits Washington County Public Schools SERVICES HOSPITALIZATION Inpatient Facility Services Outpatient Facility Services Inpatient Physician Services Outpatient Physician Services Home Health Care (90 days unlimited visits per benefit period/40 visits home health aid per benefit period) Hospice (210 day lifetime max) Skilled Nursing Facility (60 days per benefit period) MATERNITY Prenatal and Postnatal Office Visits Delivery and Facility Services Nursery Care of Newborn Artificial Insemination and In Vitro Fertilization Procedures (limited to 2 combined attempts per lifetime) MENTAL HEALTH AND SUBSTANCE ABUSE Inpatient Facility Services Inpatient Physician Services Office Visits for Mental Health and Substance Abuse EPO In-Network You Pay $100 per admission copay Maryland Point of Services (MPOS) In-Network You Pay $100 per admission copay Out-of-Network You Pay Deductible, then 30% $25 per visit $25 per visit Deductible, then 30% Deductible, then 30% $20 per visit $20 per visit Deductible, then 30% $100 per admission copay Benefits available to same extent as benefits provided for other illnesses $100 per admission copay $100 per admission copay Benefits available to same extent as benefits provided for other illnesses $100 per admission copay Deductible, then 30% Deductible, then 30% Deductible, then 30% Deductible, then 30% Deductible, then 30% 30% of Allowed Benefit 30% of Allowed Benefit $20 per visit $20 per visit Deductible, then 30% Partial Hospitalization $25 per visit Deductible, then 30% Medication Management Visit MISCELLANEOUS Durable Medical Equipment $20 per visit $20 per visit Deductible, then 30% Acupuncture $20 per visit $20 per visit Deductible, then 30% Transplants Covered as stated in the Evidence of Coverage Covered as stated in the Evidence of Coverage Covered as stated in the Evidence of Coverage Preferred Provider Organization (PPO) In-Network You Pay $100 per admission copay Out-of-Network You Pay 30%, $30 per visit 30%, 30%, $30 per visit 30%, $100 per admission copay Benefits available to same extent as benefits provided for other illnesses $100 per admission copay 30%, 30%, 30%, 30%, 30%, 30%, 30% 30% $20 per visit 30%, $30 per visit 30%, $20 per visit 30%, 30%, $20 per visit 30%, Covered as stated in the Evidence of Coverage Covered as stated in the Evidence of Coverage * No copayments or coinsurance. Members are liable for the difference between CareFirst s allowed benefit and the providers charge for services rendered by a non-participating provider. Washington County Public Schools Enrollment Guide 13
Health + Wellness Whether you re looking for health and wellness tips, discounts on health and wellness services, or support to manage a health condition, we have the resources to help you get on the path to good health. With our Health + Wellness program you can: Get healthy with programs that target specific health or lifestyle issues. Deal with unexpected health issues or medical emergencies with help from our case management program. Live with a condition with the help of a coordinated health care team, by participating in our Patient-Centered Medical Home program. Access online tools and services to help you get healthy and stay healthy. Health and wellness tools Health Education Take an active role in managing your health by visiting My Care First at www.mycarefirst.com. Find nearly 300 interactive health-related tools, a multi-media section with more than 400 podcasts, and recipes to search by food group or 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 information about your health care plan and a variety of health and wellness topics, including nutrition, physical fitness and preventive health. All issues are available online at www.carefirst.com/vitality. Health and wellness programs and resources help you and your family live a healthy life. 14 Washington County Public Schools Enrollment Guide
Wellness discount program Blue365 is an exciting program that offers exclusive health and wellness deals that will keep you healthy and happy, every day of the year. Blue365 delivers great discounts from top national and local retailers on fitness gear, gym memberships, family activities, healthy eating options and much more. Visit www.carefirst.com/wellnessdiscounts to learn more. Symptom Checker App Find out when to manage symptoms at home and when to seek medical care, locate the nearest emergency room, or look up the prescribed dosage of common over-thecounter medicines. This iphone app can be downloaded at www.carefirst.com/socialmedia. Pedometer App Count your steps, distance traveled, and calories burned for each workout with the CareFirst Ready, Step, Go! app. This free app is available to anyone who has an iphone, ipod Touch, or Android smartphone. Visit your favorite app store and search for Ready, Step, Go!. Health News Get the latest information to help you, and your family, maintain a healthy lifestyle. Sign up for our monthly electronic member newsletter at www.carefirst.com/healthnews to receive health-related articles and recipes. Getting healthy Utilization Management Our program ensures you ll receive the most appropriate care when you need it. If you have to be hospitalized, or need therapy, our team will review your case, help coordinate care with your provider and assist with discharge planning. If necessary, our team will also approve additional inpatient hospital days. Case Management If you have a serious illness or injury, our Case Management program can help you navigate through the health care system and provide support along the way. Our Case Managers, who are registered nurses, will: Work closely with you and your doctors to develop a personalized treatment plan. Coordinate necessary services. Contact you regularly to see how you re doing. Answer any of your questions. Suggest available community resources. Our Case Management program is voluntary and confidential. To enroll or for more information, call (888) 264-8648. Support during your pregnancy Our Case Managers strive to help you and your baby stay healthy during pregnancy. Once enrolled, the Case Manager will provide education and information on prenatal care and pregnancy. For more information, call (888) 264-8648. Washington County Public Schools Enrollment Guide 15
My Account Online Access to Your Claims View personalized information on your claims and out-of-pocket costs online with My Account. Simply log on to www.carefirst.com/myaccount for real-time information about your plan. Features of My Account View your deductible status and out-of-pocket costs for your current and previous plan year. Review up to one year of medical claims total charges, benefits paid and costs for a specific date range Request an ID card Sign up for electronic communications and get your information faster and more securely Signing up is easy Visit www.carefirst.com/myaccount, click on 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 the following services through My Account: Download claim forms Find in-netwok providers Mobile access View the most-visited information in My Account on your smartphone or tablet. Our mobile site is available from any browser-equipped mobile device. To try out the app, visit your favorite app store, search for CareFirst and install the CareFirst app on your device. Enjoy access to: Find A Provider Search for nearby urgent care and ER facilities, based on your current location (as determined by your device s GPS). Searchable claims information Who s eligible and covered under your policy View your ID cards (App users can also print and email ID cards) Register for My Account and maintain your security and notification preferences. For more information on our mobile site and app, visit www.carefirst.com/mobileaccess. 16 Washington County Public Schools Enrollment Guide
CareFirst BlueCross BlueShield CareFirst BlueChoice, Inc. 10455 Mill Run Circle Owings Mills, MD 21117-5559 www.carefirst.com Health benefits administered by: CONNECT WITH US: BOK5378-1N (4/14) CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both 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.