Frequently Asked Questions for EPO

Even though the EPO product only provides benefits for in-network services, it utilizes a large national network of PPO providers. So, even if you move out of the area, you will still be covered as long as you continue to seek services through in-network PPO providers. (See the About BlueCard® section for more information).

Even though the EPO product only provides benefits for in-network services, it utilizes a large national network of PPO providers. So, even if you have dependents that go to school out of the area, they will still be covered as long as they seek services from in-network PPO providers. (See the About BlueCard® section for more information).

Your State of Maryland EPO Evidence of Coverage (PDF) is available online or you may contact Member Services at 410-581-3601 or 800-225-0131 for detailed benefit information for medical or vision services.

You may order a new ID card or additional ID cards by logging into My Account and clicking on "Request ID Card" or by calling Member Services at 800-225-0131.

Your card is important to getting the most out of your health plan. You will present your card when you receive care. Always carry your membership card with you. The card lists other important telephone numbers to help you in accessing care.

Yes, always show your most up-to-date ID card to your doctor and other health care providers at your next visit. The information on the card will enable the provider to file the claim accurately and minimize claim payment delays.

The Preferred Provider Directory is available online.

Benefits are available when obtained by an in-network PPO/PPN provider or BlueCard only. No out-of-network services are available through the EPO plan.

To determine if a provider participates with the Preferred Provider network, you may search the online Provider Directory, which contains the most up-to-date provider listing available.

You have access to an expanded network of vision providers through Davis Vision* in addition to the BCBS PPO network. Present your CareFirst ID card to use your vision benefits with any participating provider in the expanded network.

Visit the State of Maryland Find a Doctor tool to view all vision providers that participate with your vision plan.

Even though the EPO product only provides benefits for in-network services, it utilizes a large national network of PPO providers. So, even if you are traveling, you will still be covered as long as you seek services from in-network PPO providers. (See the About BlueCard® section for more information).

We recognize that in emergency situations you may not always have control or the ability to look for participating providers; therefore, claims for true medical emergencies will process at the in-network level even if the provider is not a preferred provider.

The BlueCard Program® offers the same advantages provided to members who live, work or travel outside the CareFirst service area of MD, DC and Northern VA. The BlueCard Program allows members to utilize the BlueCross BlueShield national network of PPO providers. With BlueCard, if you obtain services through a preferred provider, you will receive benefits at the in-network level. Call BlueCard at 800-810-BLUE to obtain names of in-network participating providers or you can search for participating providers on the CareFirst website.

The State of Maryland follows the guidelines set by the Preventive Task Force/CDC in determining eligibility requirements.

The flu, shingles and pneumonia vaccines are currently covered as a preventive service. To help minimize the out-of-pocket costs associated with receiving the flu, shingles and pneumonia vaccines, CareFirst members can now obtain these three vaccines from their local Rite Aid, Target or CVS pharmacies as an in-network medical benefit. You may get flu, shingles and pneumonia vaccines in one of three ways:

• Office Visits: Physicians will submit claims according to a member’s benefit plan for vaccines administered in their office.
• Retail Pharmacies that Participate in CareFirst's Medical Network: By providing your CareFirst ID card, pharmacists will submit claims according to a member's medical benefit plan.
• Retail Pharmacies/Retail Clinics Not Participating in CareFirst's Medical Network: Members are responsible for submitting a medical claim form (PDF), along with an itemized receipt that includes the cost of the drug and the administration fee. Members may be asked to pay the full price of the vaccine(s) at the time of service.