Federal Employees Health Benefits Program 2019 - See page 2 for details about what is new in 2019 - CareFirst

 
Federal Employees Health Benefits Program 2019 - See page 2 for details about what is new in 2019 - CareFirst
Federal Employees Health
                                 Benefits Program 2019
See page 2 for details about
what is new in 2019.                          carefirst.com/fedhmo
Federal Employees Health Benefits Program 2019 - See page 2 for details about what is new in 2019 - CareFirst
Table of Contents
Why CareFirst?  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 1      I’m a Member
What’s New in 2019 .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 2               Member Services  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 36

Before You Decide                                                                                                  Take the Call  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 37

How Health Insurance Works .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 6                               Important Numbers and Contact Information .  .  . 38

Know before you go .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 7               HealthyBlue Advantage HDHP Option
                                                                                                                   HSA/HRA Selection Form .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 39
Patient-Centered Medical Home  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 9
                                                                                                                   Notice of Nondiscrimination and Availability of
Plan Overview and Benefits Comparison                                                                              Language Assistance Services  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 41
HealthyBlue—Standard Option  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 12                                        2019 Rate Information for
                                                                                                                   CareFirst BlueChoice, Inc.  .  .  .  .  .  .  .  .  .  .  .  .  . back cover
HDHPs and HSAs/HRAs .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 17

HealthyBlue Advantage—HDHP Option  .  .  .  .  .  .  .  . 18

In-Network Benefit Comparison . . . . . . . . . . . . . . . 22

In-Network Pharmacy Benefit Comparison  .  .  .  .  . 24

With Every Plan

Health & Wellness  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 26

Blue Rewards  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 28

BlueVision  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 30

Discount Dental Coverage .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 31

Behavioral health and addiction support .  .  .  .  .  .  . 32

CareFirst Video Visit .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 33

Global Core  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 34

The information in this booklet is a summary of the benefits available under the CareFirst BlueChoice plan. For more detailed information
please access the 2019 BlueChoice Brochure (RI 73-718) on our website at carefirst.com/fedhmo.
Why CareFirst?
CareFirst BlueChoice delivers differentiated health care to meet the unique needs of our
communities. We have built powerful relationships with more members, employers, providers
and partners in local communities across the country—and around the globe.

As a federal employee, you have the option to           Free access to preventive care
select from two comprehensive medical and
                                                        As you review the details of each plan, keep in
prescription drug plan options. Rest assured both       mind that all CareFirst BlueChoice, Inc. plans
options will provide you with the benefits of free      feature no charge, no deductible, in-network
preventive care, no out-of-pocket costs for select      benefits for the following:
services and choices on where and how you get
care. Regardless of the plan you choose, you will       ■■   Adult physicals
have access to on-line tools and resources that give    ■■   Well-child exams and immunizations
you the flexibility and information you need to get     ■■   OB/GYN visits
the most out of your plan and manage your health
                                                        ■■   Cancer screenings, including mammograms,
care and wellness goals wherever you are.
                                                             pap tests, prostate and colorectal screenings.
Delivering the best local health care,                  ■■   Preventive maternity services such as
nationwide                                                   prenatal visits, diagnostic and lab services.
■■   Most recognized and trusted brand—one in
     three Americans choose Blue                                             Highest member
■■   Unmatched provider access—97 percent of                                 satisfaction ratings
     claims paid in-network—more than any other                        CareFirst ranks best in class for
     carrier                                                 member satisfaction* in these key categories:
■■   Putting primary care providers (PCPs) at
                                                             ■■   Overall satisfaction
     the center of care—through resources and
     incentives, CareFirst BlueChoice is supporting
                                                             ■■   Likelihood to recommend
     the relationship between you and your doctor            ■■    rovide best coverage for you and
                                                                  P
                                                                  your family
■■   We have a vast network of more than 40,000
     providers in our service area (Washington DC,
                                                             ■■   Overall good reputation
     Maryland and Northern Virginia                          ■■    etworks include the doctors you
                                                                  N
                                                                  want to see
■■   More than 69,000 participating pharmacies
     are available nationwide                                * Results based on a survey of 2,638 health plan members,
                                                               conducted by Mathew Greenwald & Associates, Inc.
                                                               between January 1, 2017 and September 30, 2017.
Know you are covered with great
benefits
■■   No hidden costs—we believe so strongly in
     the value of our model, it is core to our fees
                                                             No referrals required in either
■■   Mail Service Pharmacy is a convenient and               CareFirst plan.
     fast home delivery service.
■■   Free 24/7 nurse advice line

carefirst.com/fedhmo                                   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   1
What’s New in 2019
Changes to High Option Open
Access, Standard HealthyBlue and
HealthyBlue Advantage HDHP
■■   High Option Open Access—This product will
     not be offered for the 2019 contract year.
■■   Standard HealthyBlue— Your share of the
     non-Postal premium will increase for Self
     Only; increase for Self Plus One; and increase
     for Self and Family. See back cover.
■■   HealthyBlue Advantage—Your share of
     the non-Postal premium will decrease for
     Self Only; decrease for Self Plus One; and
     decrease for Self and Family. See back cover.

Changes to Standard HealthyBlue
■■   Prescription drugs: This Plan will add a $100
     deductible for pharmacy for the Standard                                               Please see the 2019 BlueChoice Brochure for
     Option. Generic medications will not be                                                additional information about benefit changes
                                                                                            for 2019.
     subject to the deductible
■■   Prescription drugs: This Plan will decrease
     the copay for Tier 4 preferred specialty drugs                                    ■■   Orthopedic and prosthetic devices: Will
     from $150 to $100 for 34-day supply and                                                be subject to 25% coinsurance after the
     $200 for a 90-day supply                                                               deductible per device in-network and 50%
■■   X-ray/other diagnostic services: In an office/                                         coinsurance after the deductible per device
     freestanding setting will have a $40 copay in-                                         out-of-network
     network and $40 copay after the deductible                                        ■■   Sleep studies: In an office/freestanding
     out-of-network                                                                         setting will no longer be subject to the
■■   X-ray/other diagnostic services: In an                                                 deductible in-network and will have a $50
     outpatient hospital setting will be subject to                                         copay for services provided in the home
     20% coinsurance after the deductible out-of-                                           setting after the deductible
     network                                                                           ■■   Infusion services: In an office/freestanding
■■   Specialty imaging: In an office/freestanding                                           setting will no longer be subject to the
     setting will have a $60 copay in-network                                               deductible in-network and will have a $200
     and $60 copay after the deductible out-of-                                             copay for services provided in an outpatient
     network                                                                                hospital setting after the deductible

■■   Specialty imaging: In an outpatient hospital                                      ■■   Mental health services: In an outpatient
     setting will have a $60 copay after the                                                hospital setting will be subject to a $50 copay
     deductible in-network and subject to 20%                                          ■■   Ambulance services: Will have a $50 copay
     coinsurance after the deductible out-of-                                               per trip after the deductible in-network
     network                                                                                and $100 copay after the deductible out-of-
■■   Durable medical equipment: Will be subject                                             network per trip
     to 25% coinsurance after the deductible per                                       ■■   Emergency room services: Will be subject to
     device in-network and 50% coinsurance after                                            a $200 copay after the deductible
     the deductible per device out-of-network

2    ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                            carefirst.com/fedhmo
■■   Inpatient hospital admissions will be subject     ■■   Durable medical equipment will be subject
     to 20% coinsurance after the deductible                to 25% coinsurance after the deductible
     in-network and 30% coinsurance after the               per device
     deductible out-of-network                         ■■   Sleep studies in an office/freestanding setting
■■   Urgent care centers: Will have a $50                   will have a $35 copay after the deductible
     copay in-network and $80 copay after the               in-network and will have a $50 copay for
     deductible out-of-network                              services provided in the home setting after
■■   Outpatient center services/ambulatory                  the deductible
     surgical center (facility): Will have the         ■■   Infusion services in an home/office/
     following cost share based on the site of              freestanding setting will have a $25 copay
     service (in-network)                                   after the deductible in-network
       Outpatient Hospital (non-surgical)—             ■■   Inpatient hospital admissions will be subject
       $40 copay, no deductible                             to 20% coinsurance after the deductible
       Outpatient Hospital (surgical)—                      in-network and 30% coinsurance after the
       $150 copay after the deductible                      deductible out-of-network

       Freestanding/Ambulatory surgical center—        ■■   X-ray/other diagnostic services in an
       $100 copay, no deductible.                           outpatient hospital setting will be subject to
                                                            20% coinsurance after the deductible
■■   Healthy Blue Rewards program: Changes
                                                       ■■   Skilled nursing services will have the
     for participation, ongoing and coaching
                                                            following copay structure:
     rewards. The total amount of Blue Rewards
     a subscriber and/or their spouse may earn is              In-network—Facility 20% coinsurance after
     now $200 per calendar year                                deductible.
                                                               Out-of-network professional services—
Changes for HealthyBlue Advantage                              Facility 30% coinsurance of plan allowance
HDHP Option only                                               after deductible.
■■   Prescription drugs—Select Generic                         Professional services—PCP $80 copay
     medications will not be subject to the                    after deductible/specialist $80 copay after
     deductible                                                deductible
■■   Prescription drugs—This plan will decrease        ■■   Healthy Blue Rewards Program changes
     the copay for Tier 4 preferred specialty drugs         for participation, ongoing and coaching
     from $150 to $100 for 34-day supply and                rewards. The total amount of Blue Rewards
     $200 for a 90 day supply                               a subscriber and/or their spouse may earn is
■■   Premium pass through amount will increase              now $200 per calendar year.
     to $75 for Self Only enrollment and $150 Self
     Plus One and Self and Family enrollments.         Wellness and Blue Rewards changes
■■   X-ray/other diagnostic services in an office/     CareFirst’s wellness program has new, digital
     freestanding setting will have the following      features including:
     copay structure (in-network):                     ■■   The RealAge health assessment—provides
       Labs: No copay after the deductible                  the physical age of your body versus your
       X-rays—$35 copay after the deductible                calendar age

       Other diagnostic services—$35 copay
                                                       ■■   Personalized content—unique health
       after the deductible                                 newsfeed based on your preferences

       Specialty imaging—$50 copay after the
                                                       ■■   Trackers—sync your wearable devices to
       deductible                                           monitor sleep, stress, steps and more

       Out-of-network—labs, X-rays, other
                                                       ■■   Blue Rewards—your incentive program has
       diagnostic services and specialty imaging            more flexibility than before and a new online
       will be subject to 20% coinsurance after             experience
       the deductible.

carefirst.com/fedhmo                                  Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   3
Notes

4   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   carefirst.com/fedhmo
Before You Decide
How Health Insurance Works
To help you understand your health plan options,
                                                                                           Let’s                    Receive your
it’s important to understand a bit about health
                                                                                            get                       member
insurance. The graphic below explains how health
                                                                                         started!                     ID card
insurance works and defines some key terms.

                              Here are key benefits
                              you get at no charge from
                              participating providers:
                              ■■   Adult preventive visits with PCP                       Meet your deductible
                              ■■   Well-child exams and                                    Your DEDUCTIBLE is the
                                                                                            amount of money you
                                   immunizations                                              must pay each year
     Get your                 ■■   OB/GYN visits and pap tests                               before CareFirst will
    preventive                ■■   Mammograms                                                start paying for all or
       care                   ■■   Prostate and colorectal
                                                                                              part of the services.
                                                                                                                              Many of our
                                   screenings                                                     YOU PAY 100%
                                                                                          until you meet your deductible
                                                                                                                             plans do not
                              ■■   Routine prenatal maternity                                                               require you to
                                                                                                                           meet a deductible
                                   services
                                                                                                                           for primary care
                                                                                                                             and specialist
                                                                                                                              office visits,
                                   Need additional care?                                                                      urgent care,
                                                                                                                            and preventive
                                                                                                                              screenings.

            Pay your share
          After you meet your
         deductible, you’ll pay a
        COPAY or COINSURANCE                                                                                                Your premium
          for covered services.                                                                                             does not count
                                                                                                                             toward your
                    CAREFIRST                                                                                                deductible or
        YOU PAY
                    BLUECHOICE PAYS
                                                                                   Reach your annual                         out-of-pocket
                                                                                                                              maximum.
                                                                                 out-of-pocket maximum
                                                                              If you reach your OUT-OF-POCKET
                                                                             MAXIMUM, you will pay nothing for
                                                                              your care for the remainder of the
                                                                           plan year. CareFirst will pay 100 percent
                                                                              of your covered medical expenses.
                                                                                 CAREFIRST BLUECHOICE PAYS 100%

                                                                                                                             Plan year
                                                                                                                               ends

6   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                           carefirst.com/fedhmo
Know before you go
Choosing the right setting for your care—from allergies to X-rays—is key to getting the best
treatment with the lowest out-of-pocket costs. It’s important to understand your options so
you can make the best decision when you or your family members need care. The following
information may help you decide where to go for medical treatment.

     Primary care providers (PCP)                                                      Urgent care centers
The best place to get consistent, quality health care                        Urgent care centers provide treatment for injuries
is your primary care provider (PCP). If you have a                           and illnesses that require prompt medical attention
medical issue, having a doctor who knows your                                but are not life-threatening (sprains, minor cuts, flu,
health history often makes it easier to get the care                         rashes, minor burns). These centers have doctors
you need.                                                                    on staff and offer weekend/after-hours care.

     FirstHelp—Free 24/7 nurse advice line                                   Example: Patient First, ExpressCare**
When your PCP isn’t available, registered nurses                                        on-hospital facilities and
                                                                                       N
are available 24/7 to discuss your symptoms                                            surgery centers
with you and recommend the most appropriate
                                                                             X-rays, lab work and outpatient surgery will almost
care. Call 800‑535‑9700 anytime to speak with a
                                                                             always cost more in a hospital setting. Pay less
FirstHelp nurse.
                                                                             for these services by going to a participating
     CareFirst Video Visit                                                   non‑hospital facility or surgery center. Prior
When your PCP isn’t available, you can see a                                 authorization may be required for non‑hospital
doctor 24/7/365. CareFirst Video Visit allows                                outpatient services.
you to securely connect with a board certified                                             Emergency rooms
doctor* on your smartphone, tablet or computer.
                                                                             Emergency rooms treat acute illnesses and trauma.
Doctors can treat non-emergency health issues
                                                                             Go to the ER right away if you or a family member
like a sore throat, ear pain or pink eye. Visit
                                                                             have sudden symptoms that need emergency care,
carefirstvideovisit.com for more information.
                                                                             including (but not limited to): chest pain, trouble
     Convenience care centers                                                breathing or head trauma. Prior authorization is not
Convenience care centers (retail health clinics) offer                       needed for emergency room services.
care for non-emergency situations like colds, pink                                         Outpatient hospital versus
eye, strep tests and vaccinations. These centers                                           
                                                                                           inpatient hospital
usually have evening and weekend hours.
                                                                             Outpatient services are received in the
Example: CVS Minute Clinic, Walgreens                                        hospital without being admitted, such as
Healthcare Clinic**                                                          same-day surgeries. Inpatient services are
                                                                             those received when you are admitted to the
                                                                             hospital. Prior authorization may be needed for
                                                                             hospital‑based services.

To find participating providers in your plan, visit carefirst.com/fedhmo

PLEASE READ: The information provided in this document regarding various care options is meant to be helpful when you are seeking care
and is not intended as medical advice. Only a medical provider can offer medical advice. The choice of provider or place to seek medical
treatment belongs entirely to you.
*	The doctors accessed via this website are independent providers making their own medical determinations and are not employed by
   CareFirst. CareFirst does not direct the action of participating providers or provide medical advice.
**Subject to change. Visit carefirst.com/fedhmo for the most up-to-date list of available facilities.

carefirst.com/fedhmo                                                        Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   7
Know before you go

When your PCP is not available
You have full access to our expansive network of providers. When you
need care, being familiar with all your options will help you locate the
most appropriate and cost-effective medical attention.

The chart below shows how costs vary for the health plans depending
on where you receive care.

                                        HealthyBlue                     HealthyBlue
                                         Standard                        Advantage      Sample Symptoms                24/7            Rx
                                          Option*                      HDHP Option*

    CareFirst
                                                                                        ■■    ough, cold and flu
                                                                                             C
                                                                          Deductible,
                                                 $0                                     ■■   Pink eye                  ✔                ✔
    Video Visit                                                            then $0      ■■   Ear pain

    Convenience Care                                                                    ■■   Cough, cold and flu
    (e.g., CVS MinuteClinic                                               Deductible,
                                                 $0                                     ■■   Pink eye                   ✘               ✔
    or Walgreens                                                           then $0      ■■   Ear pain
    Healthcare Clinic)

    Urgent Care                                                           Deductible,
                                                                                        ■■   Sprains
    (e.g., Patient First or                     $50                                     ■■   Cut requiring stitches    ✘               ✔
    ExpressCare)                                                           then $50     ■■    Minor burns

                                                                                        ■■   Chest pain
                                         Deductible,                      Deductible,
    Emergency Room                                                                      ■■   Difficulty breathing      ✔                ✔
                                         then $200                        then $300     ■■   Abdominal pain

           Free 24/7 nurse advice line
           If you are unsure about your symptoms or where to go for care, call 800-535-9700, anytime day or night to speak to a
           registered nurse.

For more information regarding your specific benefits
and associated costs:
■■    Log in to My Account at carefirst.com/fedhmo
■■    Check your 2019 BlueChoice Brochure
■■    Call Member Services at 888-789-9065

      CareFirst Video Visit
      Register today and you will be ready when you
      need care!

      1.	 Visit carefirstvideovisit.com and click on any of
          the Video Visit links, or
      2.	 Download the CareFirst Video Visit app from your
          favorite app store

8    ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                          carefirst.com/fedhmo
Patient-Centered Medical Home
Supporting the relationship between you and your doctor

Whether you’re trying to get healthy or stay healthy, you need the best
care. That’s why CareFirst1 created the Patient-Centered Medical Home
(PCMH) program to focus on the relationship between you and your
primary care provider (PCP).
                                                                                                              A PCP is important to
The program is designed to provide your PCP with a more complete                                              your health
view of your health needs. Your PCP will be able to use information
                                                                                                              By visiting your PCP for routine
to better manage and coordinate your care with all your health care
                                                                                                              visits, you build a relationship,
providers including specialists, labs, pharmacies and others to ensure                                        and your PCP will get to know
you get access to, and receive the most appropriate care in the most                                          you and your medical history.
affordable settings.
                                                                                                              If you have an urgent health
Extra care for certain health conditions                                                                      issue, having a PCP who knows
                                                                                                              your history often makes it
If you have certain health conditions, your PCMH PCP will partner                                             easier and faster to get the care
with a care coordinator, a registered nurse, to:                                                              you need.
■■   Create a care plan based on your health needs with specific                                              Even if you are young and
     follow up activities                                                                                     healthy, or don’t visit the doctor
                                                                                                              often, choosing a PCP is key to
■■   Review your medications and possible drug interactions
                                                                                                              maintaining good health.
■■   Check in with you to make sure you’re following your
     treatment plan
■■   Assist you in obtaining services and equipment necessary to
     manage your health condition(s)

      PCPs play a huge role in keeping you healthy for the long run. If you don’t already have a
      relationship with a doctor, you can begin researching one today!
      ■■   To find a PCMH PCP,
           look for the PCMH logo
           when searching for
           primary care providers
           in our Provider Directory
           or log in to My Account
           and click Select/Change
           PCP under Quick Links.

1
    All references to CareFirst refer to CareFirst BlueCross BlueShield and CareFirst, BlueChoice, Inc., collectively.

carefirst.com/fedhmo                                                            Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   9
Notes

10   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   carefirst.com/fedhmo
Plan Overview and
     Benefits Comparison
Be informed and compare plan benefits side-by-side
HealthyBlue—Standard Option
No referrals required

With HealthyBlue—Standard Option, you’ll benefit from no out-of-pocket costs for select
services and choices on where and how you get care. CareFirst also offers online tools and
resources at carefirst.com/fedhmo that give you the flexibility to manage your health care and
wellness goals wherever you are.

                                                                                       Benefits at a glance
                                                                                              Preventive care and sick office visits
                                                                                               ou are covered for all preventive care as
                                                                                              Y
                                                                                              well as sick office visits.

                                                                                              Large provider network
                                                                                               ou can choose any doctor from our
                                                                                              Y
                                                                                              large network of providers. Our network
                                                                                              also includes specialists, hospitals and
                                                                                              pharmacies—giving you many options for
                                                                                              your health care.

                                                                                              Specialist services
                                                                                               our coverage includes services from
                                                                                              Y
Take advantage of your benefits
                                                                                              specialists without a referral. Specialists
                                                                                              are doctors or nurses who are highly
         ■■   $0 cost for comprehensive preventive                                            trained to treat certain conditions, such
              health care visits and sick office visits.                                      as cardiologists or dermatologists.
         ■■   $0 cost for generics                                                            Prescription drug coverage
         ■■   $0 cost for in-network lab and X-ray                                            Your plan covers prescription drugs.
              services
         ■■   $0 cost for convenience care                                                    Hospital services
         ■■   $0 cost for in-network professional                                             
                                                                                              You’re  covered for overnight hospital
              mental health services in the doctor’s                                          stays. You’re also covered for outpatient
              office                                                                          services, those procedures you get in
                                                                                              the hospital without spending the night.
                                                                                              Your PCP or specialist must provide prior
■■   No referrals required.                                                                   authorization for all inpatient hospital
                                                                                              services and may need to provide prior
■■   A network of almost 40,000 CareFirst BlueChoice
                                                                                              authorization for some outpatient hospital
     providers (PCPs, nurse practitioners, specialists,
                                                                                              services such as rehabilitative services,
     hospitals, pharmacies, and diagnostic
                                                                                              chemotherapy and infusion services.
     centers) in Maryland, Washington, D.C. and
     Northern Virginia.                                                                       Labs, X-rays or specialty imaging
                                                                                               overed services include provider-
                                                                                              C
■■   After-hours care, including a free 24-hour
                                                                                              ordered lab tests, X-rays and other
     nurse advice line, video visits, convenience
                                                                                              specialty imaging tests (MRI, CT scan,
     care clinics and urgent care centers.
                                                                                              PET scan, etc.).

12   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                       carefirst.com/fedhmo
Well-child visits                            Out-of-network--higher costs with more
             All well-child visits and immunizations      flexibility
             are covered.                                 You can use any Provider in or out of the CareFirst
                                                          network
             Maternity and pregnancy care
              ou are covered for doctor visits before
             Y                                            Receive greater flexibility when accessing providers
             and after your baby is born, including       while still maintaining an opportunity to save
             hospital stays. If needed, we also cover     money. In exchange for the freedom to visit
             home visits after the baby’s birth.          a providers outside the CareFirst BlueChoice
                                                          network, you’ll be responsible for some additional
             Mental health and
                                                          costs, including:
             substance use disorder
              our coverage includes behavioral health
             Y                                            ■■   Highest out-of-pocket costs and
             treatment, such as psychotherapy and              annual deductible.
             counseling, mental and behavioral health     ■■   Adult preventive care, well-child care visits
             inpatient services and substance use              and cancer screenings are subject to the
             disorder treatment.                               deductible, but do not have a copay.

How your plan works                                       Hospital authorization
In-network—biggest savings to you                         CareFirst BlueChoice providers will obtain any
You must use CareFirst BlueChoice providers               necessary admission authorizations for in-area
and facilities.                                           covered services. You will be responsible for
                                                          obtaining authorization for services provided
To get the most from your in-network benefits,
                                                          by out-of-network providers and out-of-area
remember to select a PCP for you and each
                                                          admissions. Call toll-free at 866-PREAUTH
member of your family.
                                                          (773-2884).
■■   See your PCP for all preventive care and
                                                          Prior authorization is not required for emergency
     sick visits.
                                                          admissions or maternity admissions.
■■   Pay the lowest out-of-pocket costs for
     all services.
■■   Pay the lowest annual deductible.
■■   Receive adult preventive care visits, well-child
     care visits, cancer screenings and generic
     prescription drugs at no cost.

How HealthyBlue—Standard Option network coverage works

      In-network                                            Out-of-network

                            $
          In-network you pay:                                  Out-of-network you pay:     $$
          BlueChoice network                                   BlueCard PPO network

                                                               Non-participating providers you pay:            $$$
                                                               (Balance billing may apply)

carefirst.com/fedhmo                                     Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   13
HealthyBlue—Standard Option

Your benefits                                                                          Step 3: Your plan will start to pay for services
Step 1: Select a PCP                                                                   Medical
Establishing a relationship with one doctor is                                         Your full medical benefits will become available
the best way to receive consistent, quality health                                     once your medical deductible is met. However,
care. When you enroll in a HealthyBlue Standard                                        the level of those benefits will depend on whether
Option plan, you select a PCP—either a physician                                       you see in-network or out-of-network providers.
or nurse practitioner—to manage your primary                                           Depending on your particular plan, you may also
medical care. Make sure you select a PCP for                                           have to pay a copay or coinsurance when you
yourself and each of your covered family members.                                      receive care.
Your PCP must participate in the CareFirst
                                                                                       You will have a different deductible amount for
BlueChoice provider network and must specialize
                                                                                       in-network versus out-of-network benefits and
in family practice, general practice, pediatrics or
                                                                                       the in- and out-of-network medical deductibles
internal medicine.
                                                                                       contribute toward one another. For example, when
To ensure that you receive the highest level of                                        you see in-network providers, your expenses will
benefits and pay the lowest out-of-pocket costs                                        count toward both your in-network deductible and
for all services, see your PCP for preventive and                                      out-of-network deductible.
routine care.
                                                                                       Prescription drugs
Step 2: Meet your deductible                                                           Once you meet your prescription drug deductible,
Medical deductible                                                                     you will pay a different copay amount depending
                                                                                       on whether you receive a generic, preferred brand,
You will be responsible for the cost of your medical
                                                                                       non-preferred brand, preferred specialty or non-
care up to the amount of your medical deductible.
                                                                                       preferred specialty drug.
However, this deductible does not apply to all
services.                                                                              If you go to a non-network pharmacy, you will have
                                                                                       to pay for the drug in full and file a prescription
Examples of in-network services not subject
                                                                                       reimbursement claims form (found under
to deductible*:
                                                                                       resources and forms on carefirst.com/fedhmo).
■■   Adult preventive visits and sick office visits                                    You will be reimbursed up to the allowed amount
     with PCP                                                                          minus your copay.
■■   Well-child care and immunizations with PCP
                                                                                       Medical and prescription drug deductible
■■   OB/GYN visits and pap tests                                                       requirements vary based on whether your
■■   Mammograms                                                                        coverage is self, a self + one or family plan. If
                                                                                       more than one person is covered under your plan,
■■   Prostate and colorectal screenings
                                                                                       please refer to your 2019 BlueChoice brochure for
■■   Routine prenatal maternity services
                                                                                       detailed information on deductibles.
Prescription drug deductible
You will be responsible for the cost of your
prescription drugs up to the amount of your
separate drug deductible. However the drug
deductible does not apply to generic drugs or
to preventive drugs.

* This is not a complete list of all services. For a comprehensive explanation of your coverage, please check your 2019 BlueChoice brochure
available at carefirst.com/fedhmo.

14   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                         carefirst.com/fedhmo
Step 4: Your Out-of-pocket maximum                                        Out-of-area coverage
Your out-of-pocket maximum is the maximum                                 Away From Home Care
amount you will pay during the calendar year. Any                         In addition, members and their covered
amount you pay toward your deductible and most                            dependents planning to be out of the CareFirst
copays and/or coinsurance will count toward your                          BlueChoice, Inc. service area for at least 90
combined medical and prescription drug out-of-                            consecutive days may be able to take advantage of
pocket maximum.                                                           a special program, Away From Home Care®.
Just like your deductible, there are different                            This program allows temporary benefits through
in-network and out-of-network amounts and the                             another Blue Cross and Blue Shield affiliated
in- and out-of-network out-of-pocket maximums                             HMO nationwide.* It provides coverage for routine
contribute toward one another.                                            services and is perfect for extended out‑of‑town
Please keep in mind that out-of-pocket                                    business or travel, semesters at school or families
requirements also differ if your coverage is self,                        living apart.
self + one or family plan. Detailed information on                        For more information on Away From Home Care,
out-of-pocket maximum amounts can be found in                             please call Member Services at the phone number
your 2019 BlueChoice brochure.                                            listed on the back of your ID card.

Labs, X-rays or specialty imaging                                         Enrolling in Away From Home Care
To ensure you receive the maximum laboratory                              To make sure you and your covered dependents
benefit from your plan, you must use a LabCorp(R)                         have ongoing access to care:
facility for any in-network laboratory services.
Services performed at a facility that is not part of                      ■■   Call the Member Service phone number
the LabCorp network may not be covered under                                   on your ID card and ask for the Away From
your plan. Also, any lab work performed in an                                  Home Care Coordinator.
outpatient hospital setting will require a prior                          ■■   The coordinator will let you know the name
authorization from your PCP.                                                   of the Host HMO in the area. If there are no
                                                                               participating affiliated HMOs in the area, the
LabCorp has approximately 100 location
                                                                               program will not be available to you.
throughout Maryland, Washington, D.C. and
Northern Virginia. To locate the LabCorp patient                          ■■   The coordinator will help you choose a
service center near you, call (888) LAB-CORP or visit                          primary care physician (PCP) and complete the
labcorp.com.                                                                   application. Once completed, the coordinator
                                                                               will send you the application to sign and date.
If you need X-rays or other specialty imaging
                                                                          ■■   Once the application is returned, we will send
services, you must visit a participating
                                                                               it to your Host HMO.
freestanding/non-hospital diagnostic center such
as Advanced Radiology for any in-network X-ray or                         ■■   The Host HMO will send you a new,
specialty imaging services.                                                    temporary ID card which will identify your
                                                                               PCP and information on how to access your
                                                                               benefits while using Away From Home Care.
                                                                          ■■   Simply call your Host HMO primary care
                                                                               physician for an appointment when you
                                                                               need care.
                                                                          ■■   When in the CareFirst local area use your
                                                                               home plan’s benefits.

*
    Most Blue Cross and Blue Shield plans participate in this program.

carefirst.com/fedhmo                                                     Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   15
HealthyBlue—Standard Option

Global Core
If you travel outside of the U.S., rest assured you’ll
be covered under BlueCross BlueShield Global
Core* solutions from CareFirst. You'll receive:

■■   Access to nearly 170,000 English-speaking
     providers and more than 11,500 hospitals in
     nearly 200 countries worldwide
■■   24/7 telephone support
■■   Seamless claims processing/reimbursement
     designed for occasional or short-term travel,
     the Core plan connects members with their
     home plan benefits to provide basic out-
     of-network coverage for medical services
     outside of the U.S.
For more information on Global Core, please call
800-810-BLUE (2583)
*BlueCross BlueShield Global is a brand owned by BlueCross
BlueShield Association

16   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   carefirst.com/fedhmo
HDHPs and HSAs/HRAs
Our HealthyBlue Advantage—HDHP Option may be a great choice if you want more control
over your health care spending or if saving for future medical expenses and/or retirement
is a priority for you.

HealthyBlue Advantage—HDHP Option pairs                        You can use your HSA to pay for any
a high-deductible health plan (HDHP) with                      eligible out-of-pocket health care
either a health savings account (HSA) or health                expenses. Once the annual deductible is
reimbursement arrangement (HRA).                               met ($1,400 for self; $2,800 for self + one
                                                               and family), CareFirst will begin to provide
Remember! You only have 30 days to sign up for
                                                               benefits for covered services.
an HSA, otherwise you will be enrolled in an HRA—
see page 39. For details about your eligibility        ■■   We fund your HRA account $900 for self and
to enroll in an HSA or HRA, please see the 2019             $1,800 for self + one and family.
BlueChoice Brochure available at carefirst.com/        ■■   In-network preventive care is covered in full
fedhmo.                                                     and not subject to the deductible. Once you
HSAs are medical savings accounts, which                    meet your deductible, CareFirst begins to pay
means you and your employer can make pre-                   for covered services.
tax contributions according to your budget.            ■■   With both HSAs and HRAs, your health
You can use the money in your HSA to pay for                care account can only be used for eligible
eligible medical expenses (see below) until your            medical expenses.
deductibles are met.                                           Sample eligible expenses include:
With an HRA, we fund your account to cover health              doctor and hospital visits, copayments,
care costs before the deductible has been met.                 eyeglasses, prescriptions and premiums
HRAs provide tax-free reimbursement for out-of-                for long-term care insurance. See IRS list of
pocket medical expenses. When you need to make                 eligible expenses at irs.gov.
a withdrawal, you do not pay taxes if you use it to
cover eligible expenses. Unlike HSA’s, HRA funds do
                                                       Value of the HealthyBlue Advantage—
not roll over year after year.                         HDHP Option (HSA)
                                                       ■■   Reduce your taxes—you pay no taxes on
How the accounts work                                       contributions, earnings, or withdrawals for
■■   With an HSA you are eligible for a premium             eligible medical expenses.
     pass-through amount. We contribute $75 per        ■■   Your HSA money grows tax-free over time.
     month for self and $150 per month for self +      ■■   Your HSA funds rollover from year to year to
     one and family to your HSA account.                    use on future expense.
■■   You may also contribute additional amounts        ■■   Once your balance exceeds $1,000, your HSA
     up to the maximum annual limit of $3,500               account serves as an investment opportunity,
     for individuals and $7,000 for couples and             so your unused funds can grow tax-free to
     families as allowed by the Internal Revenue            fund a nest egg for future medical costs or
     Service (IRS).                                         even for retirement—if you are 55 and older,
       A convenient BlueFund debit card gives               you can make additional contributions up to
       you quick and easy access to your HSA                the maximum IRS guidelines.
       funds for eligible medical expenses. Funds      ■■   HSAs are portable and owned by you, so it
       are deducted directly from your HSA.                 goes with you if you change jobs or leave the
                                                            federal government.

carefirst.com/fedhmo                                  Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   17
HealthyBlue Advantage—HDHP Option
No referrals required

HealthyBlue Advantage—HDHP Option offers both in- and out-of-network coverage providing
flexibility and choice. Referrals are not required to seek care from a participating specialist adding
convenience and easy access to care. Access online tools and resources at carefirst.com/fedhmo
that give you the flexibility to manage your health care and wellness goals wherever you are.

                                                                                       Benefits at a glance
                                                                                              Preventive care and sick office visits
                                                                                               ou are covered for all preventive care as
                                                                                              Y
                                                                                              well as sick office visits.

                                                                                              Large provider network
                                                                                               ou can choose any doctor from our
                                                                                              Y
                                                                                              large network of providers. Our network
                                                                                              also includes specialists, hospitals and
                                                                                              pharmacies—giving you many options for
                                                                                              your health care.

                                                                                              Specialist services
Take advantage of your benefits                                                                our coverage includes services from
                                                                                              Y
■■   $0 cost for comprehensive preventive health                                              specialists without a referral. Specialists
     care visits.                                                                             are doctors or nurses who are highly
                                                                                              trained to treat certain conditions, such
■■   No referrals required.                                                                   as cardiologists or dermatologists.
■■   A network of almost 40,000 CareFirst BlueChoice                                          Prescription drug coverage
     providers (PCPs, nurse practitioners, specialists,                                       Your plan covers prescription drugs.
     hospitals, pharmacies, and diagnostic
     centers) in Maryland, Washington, D.C. and
                                                                                              Hospital services
     Northern Virginia.
                                                                                              
                                                                                              You’re  covered for overnight hospital
■■   After-hours care, including a free 24-hour                                               stays. You’re also covered for outpatient
     nurse advice line, video visits, convenience                                             services, those procedures you get in
     care clinics and urgent care centers.                                                    the hospital without spending the night.
                                                                                              Your PCP or specialist must provide prior
■■   If you need care outside the CareFirst
                                                                                              authorization for all inpatient hospital
     BlueCross BlueShield (CareFirst) service
                                                                                              services and may need to provide prior
     area of Maryland, Washington, D.C. and
                                                                                              authorization for some outpatient hospital
     Northern Virginia, you have access to
                                                                                              services such as rehabilitative services,
     thousands of providers in all 50 states and
                                                                                              chemotherapy and infusion services.
     receive in-network benefits when you see a
     BlueCard® PPO provider.                                                                  Labs, X-rays or specialty imaging
                                                                                               overed services include provider-
                                                                                              C
                                                                                              ordered lab tests, X-rays and other
                                                                                              specialty imaging tests (MRI, CT scan,
                                                                                              PET scan, etc.).

18   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                       carefirst.com/fedhmo
Well-child visits                            If you receive services from a provider outside of
             All well-child visits and immunizations      the BlueChoice or national BlueCard PPO provider
             are covered.                                 network, you may have to:

             Maternity and pregnancy care                 ■■   Pay higher out-of-pocket costs
              ou are covered for doctor visits before
             Y                                            ■■   Pay the provider’s actual charge at the time
             and after your baby is born, including            you receive care
             hospital stays. If needed, we also cover     ■■   File a claim for reimbursement
             home visits after the baby’s birth.
                                                          ■■   Satisfy a higher deductible and/or
             Mental health and                                 coinsurance amount
             substance use disorder
                                                          Receiving care outside the CareFirst
              our coverage includes behavioral health
             Y
                                                          service area
             treatment, such as psychotherapy and
             counseling, mental and behavioral health     Members seeking care outside the CareFirst
             inpatient services and substance use         service area will pay the lowest costs by using a
             disorder treatment.                          national BlueCard PPO provider for in-network
                                                          coverage. Members will still have the option
How your plan works                                       to opt-out of this network but will pay a higher
Receiving care inside the CareFirst                       out-of-pocket expense.
service area                                              If you receive services from a provider outside of the
When you need care in Maryland, Washington, D.C.          national BlueCard PPO network when you are out of
or Northern Virginia, select a provider in the            the CareFirst service area, you will have to:
CareFirst BlueChoice network to receive in-network
                                                          ■■   Pay the provider’s actual charge at the time
coverage and pay the lowest out-of-pocket costs.
                                                               you receive care
If you receive care within our service area but           ■■   File a claim for reimbursement
outside the BlueChoice network, your benefits
                                                          ■■   Satisfy a deductible and coinsurance/copays
will be paid at the out-of-network level, but
you’ll incur lower costs by using a participating         The choice is entirely yours. That’s the advantage of
national BlueCard PPO provider. To find a national        this plan.
participating provider, visit bcbs.com.

            How HealthyBlue Advantage—HDHP Option network coverage works
                 When you receive care inside the                      When you receive care outside the
                 CareFirst BlueChoice service area:                    CareFirst BlueChoice service area:

         In-network you pay: $
         BlueChoice network                                    In-network you pay: $
                                                               BlueCard PPO network

         Out-of-network you pay: $$
         BlueCard PPO network

         Non-participating providers you pay:   $$$            Non-participating providers you pay:                   $$$
         (Balance billing may apply)                           (Balance billing may apply)

carefirst.com/fedhmo                                     Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   19
HealthyBlue Advantage—HDHP Option

Hospital authorization                                                                 Step 2: Your plan will start to pay for services
CareFirst BlueChoice providers will obtain any                                         Your full benefits will become available once
necessary admission authorizations for in-area                                         your combined medical and prescription drug
covered services. You will be responsible for                                          deductible is met. However, the level of those
obtaining authorization for services provided                                          benefits will depend on whether you see
by out-of-network providers and out-of-area                                            in-network or out-of-network providers. You
admissions. Call toll-free at 866-PREAUTH                                              may also have to pay a copay or coinsurance
(773-2884).                                                                            when you receive care.

                                                                                       You will have a different deductible amount for
Your benefits
                                                                                       in-network versus out-of-network benefits and
Step 1: Meet your deductible                                                           the in- and out-of-network medical deductibles
You will be responsible for the cost of your medical                                   contribute toward one another. For example, when
care and prescription drugs up to the amount of                                        you see in-network providers, your expenses will
your deductible. However, this deductible does not                                     count toward both your in-network deductible and
apply to all services.                                                                 out-of-network deductible.

Examples of in-network services not subject                                            Deductible requirements vary based on whether
to deductible*:                                                                        your coverage is self, self + one or family plan. If
                                                                                       more than one person is covered under your plan,
■■   Adult preventive visits with PCP
                                                                                       please refer to your 2019 BlueChoice brochure for
■■   Well-child care and immunizations with PCP                                        detailed information on deductibles.
■■   OB/GYN visits and pap tests
                                                                                       Step 3: Your out-of-pocket maximum
■■   Mammograms
                                                                                       Your out-of-pocket maximum is the maximum
■■   Prostate and colorectal screenings                                                amount you will pay during the calendar year
■■   Routine prenatal maternity services                                               for covered medical and pharmacy services. Any
■■   Preventive drugs                                                                  amount you pay toward your deductible, copays
                                                                                       and coinsurance will count toward your combined
■■   HealthyBlue Select Generics—
                                                                                       medical and prescription drug out-of-pocket
     Preferred generic drugs to treat asthma,
                                                                                       maximum.
     blood pressure, cholesterol, depression
     and diabetes.                                                                     Just like your deductible, there are different
                                                                                       in-network and out-of-network amounts and the
                                                                                       in- and out-of-network out-of-pocket maximums
                                                                                       contribute toward one another.

                                                                                       Please keep in mind that out-of-pocket
                                                                                       requirements also differ if your coverage is a self,
                                                                                       self + one or family plan. Detailed information on
                                                                                       out-of-pocket maximum amounts can be found in
                                                                                       your 2019 BlueChoice brochure.

* This is not a complete list of all services. For a comprehensive explanation of your coverage, please check your 2019 BlueChoice brochure on
our website at carefirst.com/fedhmo.

20   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                          carefirst.com/fedhmo
Labs, X-rays or specialty imaging                                        Out-of-area coverage
If you access laboratory services inside the                             You have the freedom to take your health care
CareFirst service area of Maryland, Washington,                          benefits with you across the country. BlueCard
D.C. and Northern Virginia you must use LabCorp                          PPO, a program from the Blue Cross and Blue
as your lab test facility for in-network benefits.                       Shield Association, allows you to receive the
Services performed by any other provider, while                          same health care benefits while traveling outside
inside the CareFirst service area, will be considered                    of the CareFirst service area of Maryland,
out-of-network and subjected to higher out-of-                           Washington, D.C. and Northern Virginia. The
pocket costs.                                                            BlueCard program includes more than 6,100
                                                                         hospitals and 600,000 other health care providers
LabCorp has approximately 100 locations
                                                                         nationally.
throughout Maryland, Washington, D.C. and
Northern Virginia. To locate a LabCorp patient                           Global coverage
service center near you, call 888-LAB-CORP                               If you travel outside of the U.S., rest assured you’ll
(522-2677) or visit labcorp.com.                                         be covered under BlueCross BlueShield Global
If you access laboratory services outside of                             Core* solutions from CareFirst. You'll receive:
Maryland, D.C. or Northern Virginia, you may use                         ■■   Access to nearly 170,000 English-speaking
any participating BlueCard PPO facility and receive                           providers and more than 11,500 hospitals in
in-network benefits. To find laboratory service                               nearly 200 countries worldwide
providers outside of the CareFirst service area, visit
                                                                         ■■   24/7 telephone support
our Find a Provider tool (carefirst.com/doctor) and
search by Labs.                                                          ■■   Seamless claims processing/reimbursement
                                                                              designed for occasional or short-term travel,
If you need X-rays or other specialty imaging                                 the Core plan connects members with their
services when inside the CareFirst service area, you                          home plan benefits to provide basic out-
must visit a participating freestanding/non-hospital                          of-network coverage for medical services
diagnostic center such as Advanced Radiology. If                              outside of the U.S.
you need X-rays or other specialty imaging services
                                                                         For more information on Global Core, please call
when outside the CareFirst service area, you may
                                                                         800-810-BLUE (2583).
use any participating BlueCard PPO facility and
receive in-network benefits.

*BlueCross BlueShield Global is a brand owned by BlueCross BlueShield Association

carefirst.com/fedhmo                                                   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   21
In-Network Benefit Comparison*
                                                                             HealthyBlue                          HealthyBlue Advantage
 Services
                                                                           Standard Option                             HDHP Option
 BLUE REWARDS
                                                                        Blue Rewards is an incentive program where you may earn up to $200
                                                                            for taking an active role in getting healthy and staying healthy.
 ANNUAL DEDUCTIBLE (Calendar year)
                                                                                                                    Combined medical and
                                                                                                                prescription drug deductible:
                                                                          Medical deductible:
 Applies at contract level not individual                                                                               $1,400 Self Only
                                                                             $500 Self Only
 member level                                                                                                 $2,800 Self + One / Self and Family
                                                                   $1,000 Self + One / Self and Family
                                                                                                            Monthly premium pass through amount
                                                                                                             $75 Self, $150 Self + One and Family
 ANNUAL OUT-OF-POCKET MAXIMUM (Calendar year)
 Medical and Prescription Drug
                                                                           $2,500 Self Only                            $4,000 Self Only
 (Maximums include all copays,
                                                                   $5,000 Self + One/ Self and Family          $6,500 Self + One/ Self and Family
 coinsurance and deductible amounts)
 PREVENTIVE SERVICES
 Well-Child Care Visit / Adult Physical
                                                                                 No charge                                 No charge
 Examination (including routine GYN visit)

 Breast, Prostate, Colorectal Screening                                          No charge                                 No charge

 PCP AND SPECIALIST SERVICES
                                                                              PCP: No charge                    PCP: Deductible ,then no charge
 Office Visits for Illness—PCP1 / Specialist1
                                                                              Specialist: $40                   Specialist: Deductible, then $35
 Convenience Care (Retail Health Clinic)
                                                                                 No charge                         Deductible, then no charge
 Example: CVS Minute Clinic1

 CareFirst Video Visit 1                                                         No charge                         Deductible, then no charge

 Allergy Shots and Testing1                                                             $40                           Deductible, then $35

 Physical, Speech and Occupational
                                                                                        $40                           Deductible, then $35
 Therapy 1

 Acupuncture 1 and Chiropractic Services 1                                              $40                           Deductible, then $35

 EMERGENCY SERVICES

 Urgent Care1                                                                           $50                           Deductible, then $50

 Ambulance (if medically necessary)                                        Deductible, then $50                       Deductible, then $50

 Hospital Emergency Room Services (Members are responsible for both physician and facility fees)

 ■■   Facility (waived if admitted)                                       Deductible, then $200                      Deductible, then $300

                                                                            PCP: No charge
 ■■   Physician                                                                                                    Deductible, then no charge
                                                                    Specialist: Deductible, then $40
 DIAGNOSTIC SERVICES (Non-hospital/Freestanding facility)

 Labs1                                                                           No charge                        Deductible, then no charge2

 X-ray1                                                                                 $40                          Deductible, then $352

 Specialty imaging1
                                                                                        $60                          Deductible, then $502
 (MRA/MRS, MRI, PET and CT scans)

* This summary is for comparison purposes only & does not create rights not given through the benefit plan. Please refer to your 2019
  FEHBP BlueChoice Contract for specific plan details.

22    ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                                carefirst.com/fedhmo
Visit carefirst.com/fedhmo for more information.
                                  Existing members can use My Account to access details on their specific plan and benefits.

                                                                  HealthyBlue                                HealthyBlue Advantage
 Services
                                                                Standard Option                                   HDHP Option
 HOSPITALIZATION (Members are responsible for both physician and facility fees)
 Outpatient Center Services / Ambulatory Surgical Center

 ■■   Facility                                                          $100                                     Deductible, then $100

 ■■   Physician                                                Deductible, then $40                               Deductible, then $35

 Outpatient Hospital Surgical Services

 ■■   Facility                                                 Deductible, then $150                             Deductible, then $300

 ■■   Physician                                                Deductible, then $40                               Deductible, then $35

 Inpatient Hospital Services (Incudes Mental Health and Substance Use Disorder and IP Maternity)

 ■■   Facility                                       Deductible, then 20% of Allowed Benefit          Deductible, then 20% of Allowed Benefit

 ■■   Physician                                                Deductible, then $40                               Deductible, then $35

 MENTAL HEALTH AND SUBSTANCE USE DISORDER (Members are responsible for both physician and facility fees)

 Office Visits1                                                      No charge                                Deductible, then no charge

 MEDICAL DEVICES AND SUPPLIES

 Durable Medical Equipment                           Deductible, then 25% of Allowed Benefit          Deductible, then 25% of Allowed Benefit

 1
      Per Visit
 2
      Members receiving lab services INSIDE the CareFirst Service area (MD, D.C., N. VA) MUST use LabCorp as their Lab Test Facility
      and a non-hospital/freestanding facility for X-Rays and Imaging services for in-network benefits. Services performed by any
      other provider, while inside the CareFirst service area will be considered out-of-network. Members receiving Laboratory,
      x-rays, imaging services OUTSIDE of MD, D.C., or N. VA, may use any participating BlueCard PPO facility and receive in-
      network benefits.

       For out-of-network benefits please visit our website at carefirst.com/fedhmo to access
       the 2019 BlueChoice Brochure.

carefirst.com/fedhmo                                                         Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   23
In-Network Pharmacy Benefit Comparison
                                                                           Healthy Blue—                  HealthyBlue Advantage—
                                                                          Standard Option                       HDHP Option
    Plan Feature                                             Amount                                  Amount
    Deductible1                                              $100 deductible                         $1,400 Individual
                                                                                                     $2,800 Self + One
                                                                                                     $2,800 Family
    Catastrophic limit (out-of-pocket                        $2,500 Individual                       $4,000 Individual
    maximum) Applies to medical and                          $5,000 Self + One                       $6,500 Self + One
    prescription services provided in‑network2               $5,000 Family                           $6,500 Family
    Preventive Drugs                                         $0 (not subject to deductible)          $0 (not subject to deductible)
    Examples: folic acid, fluoride and FDA
    approved contraceptives for women
    (up to a 34-day supply)
    Generic Drugs (Tier 1)                                   $0 (not subject to deductible)          $0 (subject to deductible)3
    (up to a 34-day supply)
    Preferred Brand Drugs (Tier 2)                           $35 (subject to deductible)             $30 (subject to deductible)
    (up to a 34-day supply)
    Non-preferred Brand Drugs (Tier 3)                       $65 (subject to deductible)             $60 (subject to deductible)
    (up to a 34-day supply)
    Preferred Specialty Drugs (Tier 4)4                      $100 (subject to deductible)            $100 (subject to deductible)
    (up to a 34-day supply)
    Non-preferred Specialty Drugs (Tier 5)                   $150 (subject to deductible)            $150 (subject to deductible)
    (up to a 34-day supply)
    Maintenance Copays                                       (All maintenance drugs except generic   (All maintenance drugs subject to
    (up to a 90-day supply)                                  subject to deductible)                  deductible)
                                                             Generic: $0                             Generic: $0
                                                             Preferred Brand: $70                    Preferred Brand: $60
                                                             Non-preferred Brand: $130               Non-preferred Brand: $120
                                                             Preferred Specialty: $200               Preferred Specialty: $200
                                                             Non-preferred Specialty: $300           Non-preferred Specialty: $300

    Some prescription drugs require prior authorization. Prior authorization is a tool used to ensure that you will achieve the maximum
    clinical benefit from the use of specific targeted drugs. Your physician or pharmacist must call 800-241-3371 to begin the prior
    authorization process.
1
    Once you meet your deductible, you will pay a different copay amount depending on whether you receive a generic, preferred brand,
    non‑preferred brand, preferred specialty or non-preferred specialty drug.
2
    Once you reach your out-of-pocket maximum, CareFirst BlueChoice will pay 100% of the applicable allowed benefit for most covered services
    for the remainder of the year.
3
    HealthyBlue Advantage—HDHP Option Select Generics are not subject to the deductible. These are preferred generic drugs to treat asthma,
    blood pressure, cholesterol, depression and diabetes.
4
    Preferred specialty drugs: Consist of brand-name specialty drugs that are used to treat chronic, complex and/or rare health conditions. These
    drugs generally are a more cost-effective alternative to non-preferred specialty drugs.
Specialty drugs must be filled through the Exclusive Specialty Pharmacy Network.

                 Drug Calculator Tool                                Saving Tips                                  Drug List
         There is a Drug Calculator                          Don’t forget to ask your doctor or            See complete list of drugs at
         Tool available on                                   check the online Preferred Drug List          carefirst.com/fedhmo or call
         carefirst.com/fedhmo under                          to see if there is a generic or preferred     800‑241‑3371.
         Plan Information > Prescription                     brand alternative drug available. You
         Drug Benefits. This interactive                     could potentially save by switching
         tool helps you find information                     to a compatible generic or preferred
         on covered drugs, out-of-                           brand (Tier 2) drug.
         pocket drug costs and lower
         cost alternatives.

24   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                               carefirst.com/fedhmo
With Every Plan
Health & Wellness
Putting the power of health in your hands

Improving your health just got easier! CareFirst BlueCross BlueShield has partnered with
Sharecare* to bring you a new, highly personalized wellness program. Catering to your unique
health and wellness goals, our program offers motivating digital resources—accessible
anytime—to help you live a healthier life.

Ready to take charge of your health?
Want to find out if your healthy habits are truly
making an impact? Take the RealAge® health
assessment! In just a few minutes, RealAge will
help you determine the physical age of your body
versus your calendar age. You’ll discover the lifestyle
behaviors helping you stay younger or making you
age faster and receive insightful recommendations
based on your results.

Exclusive features
Our wellness program is full of tailored resources
and tools that reflect your own preferences and
interests. You get:

■■   A personalized health newsfeed: Receive
     insights, content and services.
■■   Trackers: Connect your wearable devices to
     monitor daily habits like sleep, steps, nutrition
     and more.
                                                                                        Download the mobile app to
■■   Challenges: Having trouble staying motivated?                                      access wellness tools and resources
     Join a challenge to make achieving your health
                                                                                        whenever and wherever you want.
     goals more entertaining.
■■   A health profile: Access your important health
     data like biometric information, vaccine history,
     lab results and medications all in one place.

*Sharecare, Inc. is an independent company that provides health improvement management services to CareFirst members.

26   ■   Federal Employees Health Benefits Program   ■   2019 Health Benefit Options                                    carefirst.com/fedhmo
Specialized Programs
The following programs can help you focus on                  Additional offerings
specific wellness goals.                                      ■■   Blue Rewards incentive program—
                                                                   You can earn financial incentives for
Health coaching
                                                                   participating in activities like taking
You may receive a call or email inviting you to
                                                                   the RealAge test and consenting to
participate in health coaching. Coaches are
                                                                   receive wellness emails. Visit
registered nurses and trained professionals who
                                                                   carefirst.com/sharecare.
provide one-on-one support to help you reach
                                                              ■■   Wellness discount program—
your wellness goals. If you are contacted, we
                                                                   Sign up for Blue365 at
encourage you to take advantage of this voluntary
                                                                   carefirst.com/wellnessdiscounts to
and confidential program that can help you achieve
                                                                   receive special offers from top national
your best possible health.
                                                                   and local retailers on fitness gear, gym
Weight management program                                          memberships, healthy eating options
If you are age 18 or older, have a body mass index                 and more.
(BMI) of 30 or greater and are looking to lose                ■■   Vitality magazine—Read our member
weight, our weight management program offers a                     magazine which includes important plan
personalized solution for long-term weight loss.                   information at carefirst.com/vitality.
Tobacco cessation program                                     ■■   Health education—View our
                                                                   health library for more health and
Quitting smoking and other forms of tobacco
                                                                   well-being information at
can lower your risk for many serious conditions
                                                                   carefirst.com/livinghealthy.
from heart disease and stroke to lung cancer. Our
program’s expert guidance, support and wealth of
tools make quitting easier than you might think.

Financial well-being program
Learn how to take small steps toward big
improvements in your financial situation. Whether
you want to stop living paycheck to paycheck, get
out of debt, or send a child to college, our financial
well-being program can help.

    To get started, visit carefirst.com/sharecare. You’ll need to enter your
    CareFirst account username and password and complete the one-time
    registration with Sharecare to link your CareFirst account information.
    This will help personalize your experience.

carefirst.com/fedhmo                                     Federal Employees Health Benefits Program   ■   2019 Health Benefit Options   ■   27
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