Frequently asked questions
Wherever you go, we’ve got you covered. For assistance with our plans, call 855-541-3985.
Click on one of the categories below for Frequently Asked Questions related to that subject.
As part of the Patient Protection and Affordable Care Act, the preventive services listed below for children and adults must be covered at no cost to members when using in-network providers.
These preventive services are covered where clinically appropriate, as recommended by the United States Preventive Services Task Force and supporting evidence. Limitations may apply regarding availability, setting, frequency or method of service/treatment.
Preventive Services for Children:
- Well-child visits (birth to age 21)
- Immunizations
- Preventive drugs
- Health, diet and weight counseling for qualifying children
- Alcohol and drug assessments for older children
Preventive Services for Adults:
- Preventive care visits (including screenings and counseling)
- Prenatal and postnatal care
- Immunizations
- Preventive drugs
- Breastfeeding support, supplies and counseling
- FDA-approved contraceptives
- Health, diet and weight counseling for qualifying adults
- Human Papilloma Virus (HPV) testing
- Tobacco use screenings and cessation counseling
- Fall prevention
- BRCA testing
With access to nearly 95% of all physicians in the United States, your doctor is almost certainly in the national network.
Visit our online Find a Doctor tool and search by the CareFirst BlueCross BlueShield plan or by your doctor’s name.
Outside the United States, when you have BlueCross BlueShield Global Core, you have access to doctors and hospitals in nearly 200 countries and territories. For more information visit BlueCross BlueShield Global Core.
The ability for us to process your enrollment depends on our receipt of complete and accurate data from the DC Health Link. Once we receive this, you should receive your enrollment packet and member ID card within 5-7 business days.
If you have not received the enrollment packet, your first call should be to your Health Benefits Officer. You can also reach out to the DC Health Link as noted below:
- Online: DC Health Link
- By phone: 855-532-LINK (5465)
- TTY/TDD: 771-1-532-5465
If you received your enrollment packet, but haven’t received your member ID card by January 1, please call the dedicated member service line at 855-792-2587, 8 a.m. - 6 p.m., Monday-Friday. They will be able to give you your member ID number in case you need to receive care or want to sign up for My Account.
Separate Deductible: Although the entire family deductible must be met, once each family member meets his or her individual deductible amount, they can start receiving benefits. Each family member cannot contribute more than the individual deductible amount.
Aggregate Deductible: The family deductible must be met before any member can begin receiving benefits. The deductible may be met by one member or any combination of family members.
For security reasons, you will be locked out of My Account after five unsuccessful attempts.
- If you forget your username and/or password, or get locked out of your account, you may look them up by clicking the “Forgot Username/Password?” link on the My Account Log In page. You will need your member ID number to retrieve your information.
- Or, you can request your User ID and password by calling the dedicated member service line at 855-792-2587, 8 a.m. - 6 p.m., Monday-Friday.
If you are still having trouble, call My Account Technical Support at 877-526-8390.
- Visit carefirst.com/congress and click "Log In” on the homepage.
- Click “Register Now.”
- Click on the type of plan you have.
- Enter your member ID and information.
- Enter your email address and phone number.
- We’ll send a security code to the email you provided. Enter the code.
- (Skip this step if you did not enter a phone number) We'll text a security code to the number you provided. Enter the code.
- Create a username, then create a password.
- Read and accept the Terms of Use.
- Read and agree to receiving information electronically. (This step is not required and can be changed in “settings” once registered.)
- Log in to My Account
- Click on “CLAIMS & EOBs” in the main menu.
- Click on “View My Explanation of Benefits (EOB)” from the drop-down menu.
- Click on the “Open Printable EOB” link for each EOB you wish to print.
Through My Account, you can:
- View Explanation of Benefits (EOBs)
- Access your Blue Rewards
- Find a Doctor
- Access drug and pharmacy resources
- Check claims
- Use our Hospital Comparison Tool
- Change your PCP
- Learn about the Wellness Discount Program
- View your Member Health Record
- Access plan resources
- View and request ID cards
- Update your other insurance
Benefits are available for covered services received from doctors and other providers who participate with another BlueCross and BlueShield (BCBS) plan. The BlueCard program will put you in touch with these local network providers. Call BlueCard Access at 800-810-2583 or use our Find A Doctor tool for a list of participating providers.
Benefits are covered for emergency services received from doctors who do not participate with a BCBS plan. However, you may be financially responsible for balances over the allowed benefit.
When you need care, simply show your member ID card and the hospital or doctor can submit the claims. However, if payment is required up-front, contact Member Services to obtain a claim form for consideration and reimbursement of charges.
Yes, you will receive the highest level of benefits for emergency care whether you visit an in- or out-of-network provider.
After CareFirst receives your claim, we will submit the claim on your behalf to the local BlueCross BlueShield plan where you received healthcare services. Whether you submitted the claim via email or My Account, please allow this process to take up to 30 days.
The DC Health Link will be providing various informational outreach and training sessions during open season. Your Health Benefits Officer can provide the dates, times and locations of these events. DC Health Link is also available online or by phone noted below:
- Online: DC Health Link
- By phone: 855-532-LINK (5465)
- TTY/TDD: 771-1-532-5465
There are several ways to contact the DC Health Link:
- Online: DC Health Link
- By phone: 855-532-LINK (5465)
- TTY/TDD: 771-1-532-5465
To make any changes, you will need to contact your Health Benefits Officer.
During the year, you may experience a "qualifying life event" that can make you eligible for a Special Enrollment Period to enroll in health coverage. Examples of qualifying life events include moving to a new state, certain changes in your income, and changes in your family size (for example, if you marry, divorce, or have a baby). Refer to the "Eligibility and Enrollment - Members of Congress/Staff" section of the OPM website for a list of qualifying life events.
If you experience a qualifying life event, contact your Health Benefits Officer to update your benefits information and enrollment.
There are several ways to contact the DC Health Link:
- Online: DC Health Link
- By phone: 855-532-LINK (5465)
- TTY/TDD: 771-1-532-5465
If you have been unsuccessful in contacting the DC Health Link via phone or web, we recommend that you advise your Health Benefits Officer and allow them to intervene on your behalf.
Specialty drugs are used to treat complex and/or rare health conditions. In most cases, these are high-cost prescription drugs that may require special handling, administration or monitoring and may be oral or injectable medications. Here is a list of specialty drugs (PDF).
Specialty medications must be filled through an exclusive specialty pharmacy like CVS Caremark Specialty Pharmacy in the CareFirst network. Review the Specialty Drug List (PDF).
Most medications administered by a provider are not dispensed by a retail pharmacy such as CVS or Walgreens. Your healthcare provider will usually supply and administer the medication when you come for your appointment, then bill your insurance company.
Non-preferred brand drugs often have a generic or preferred brand drug option where your cost-share will be lower. If you fill a non-preferred brand drug when a generic alternative is available, you will pay the non-preferred brand copay or coinsurance plus the cost difference between the generic and non-preferred brand drug, even if your doctor states Dispense as Written (DAW) on the prescription. There is an exception process if you need the brand-name drug to be covered for medical necessity reasons. Your doctor may submit a brand exception request. To view this form, visit our Drug Forms.
With mandatory generics, you save the most by using generic drugs (when available) versus brand-name drugs. If you decide to purchase a brand-name drug when a generic is available, you will pay the non-preferred brand copay plus the cost difference between the generic and brand-name drug.
When you get a prescription from your provider, make sure it states it is for a 12-month supply and the contraceptive being prescribed is FDA approved. If a copay is due, you will be expected to pay the appropriate copay for the entire 12-month supply. For example: 90-day copay x 4 = 12-month supply.
If you use a non-participating pharmacy you will be responsible for the full cost of the prescription and will need to submit a Prescription Reimbursement Claim Form for eligible reimbursement. To view this form, visit our Drug Forms.