CareFirst Blue Cross Blue Shield of Maryland


About CareFirst

CareFirst BlueCross BlueShield has been helping people make sense of their health care options for more than 70 years. CareFirst is an independent licensee of the Blue Cross and Blue Shield Association and is the largest health care insurer in the Mid-Atlantic region, serving more than 3.2 million members in Maryland, the District of Columbia, Delaware and portions of northern Virginia.

  • Is the largest health care insurer in the Mid-Atlantic region, serving nearly 3.4 million members
  • Employs more than 5,200 associates in the District of Columbia, Maryland, Northern Virginia, North Carolina and West Virginia
  • Includes more than 80 percent of all providers in Maryland and National Capital Area participating in one or more of its provider networks
  • Has received 13 consecutive national Brand Excellence awards, recognizing its customer service, financial strength, membership growth and promotion of the Blue brand name.

Comparing Plans

CareFirst BlueCross BlueShield (CareFirst) offers several types of health plans. The chart below will help you compare the features of our plans.

Type of Plan Advantages Other Considerations
HMO
Health Maintenance Organization
  • Usually the least expensive choice
  • Your PCP and providers handle the paperwork
  • Copayments are usually known in advance. (Deductibles and/or coinsurance may apply in some plans.)
  • With BlueChoice HMO, visits to a specialist usually require a referral from your PCP
  • With BlueChoice HMO Open Access, no referrals from your PCP are required to see a specialist
  • Very limited coverage out of the HMO’s service area
  • HMOs have a smaller network of providers than PPO or Traditional Indemnity plans
  • Seeing an out-of-network provider usually means you will pay the entire cost
Point of Service and
Opt-Out

Combines the features of managed care with out-of-network benefits
  • Includes benefits of an HMO and access to out-of-network providers
  • When you use your PCP to coordinate care, you’ll pay the lowest cost and they’ll handle the paperwork
  • Copayments for in-network services are known in advance. (Deductibles may apply in some plans.)
  • More expensive than an HMO (but usually less expensive than a PPO)
  • Using out-of-network providers will cost you more
  • Coverage for out-of-area services will vary; check the plan carefully to understand costs
Preferred Provider Organization
The health plan has negotiated rates with a network of providers.
  • Flexible
  • Large choice of providers
  • No referrals required
  • You are not required to choose a PCP
  • Preferred Providers will usually handle paperwork for you
  • Coverage for out-of-area services is usually included; check the plan carefully to understand availability and costs
  • Usually more expensive than an HMO or POS plan
  • Many services will require that you pay a deductible and coinsurance
  • Using out-of-network providers will cost you more
Indemnity
Also called “comprehensive” or “fee for service” coverage
  • Very flexible
  • Largest choice of providers
  • No referrals required
  • You are not required to choose a PCP
  • Participating providers usually accept the allowed benefit and can save you money
  • Coverage for out-of-area services is usually included; check the plan carefully to understand availability and costs
  • Offered less often than other plans
  • Usually more expensive than other plans
  • You may have to file your own claims if your provider does not participate with the plan
  • If your provider does not accept the allowed benefit you may be responsible for all additional charges
  • Deductible and coinsurance usually applies
BlueFund Consumer Directed Health Plans
Combines a PPO with an employer-funded Health Reimbursement Arrangement (HRA), or an employer and/or employee-funded Health Savings Account (HSA).
  • Same flexibility and advantages as traditional PPOs
  • Freedom to select any doctor
  • Full coverage for routine preventive care when using in-network providers
  • Members can use money in HRA/HSA for out-of-pocket health related expenses.
  • Unspent HRA/HSA funds roll over to next year in members’ medical funding account
  • Online tools help keep track of medical funding account balance
  • No claims to fill out for in-network services and out-of-network services by participating providers
  • Large national network of preferred and participating providers through¬†BlueCard¬†program
  • Value-added programs for non-covered services such as fitness memberships, laser vision correction and more

With any of these plans, you are covered for a wide range of services, which may include:

  • Annual physical exams
  • Well-child visits and immunizations
  • Hospital Care
  • Doctor office visits
  • Discounts on alternative therapies: Options provides discounts on alternative therapies including acupuncture, massage therapy and chiropractic care. It also provides discounts for fitness center memberships.

(Note: Not all plans are available to all employer groups and some are only available in specific service areas. Please check with your benefits administrator to learn what’s available to you.

Deductible, copayments or coinsurance may apply. Exclusions and limitations will apply; see your evidence of coverage for details.