Frequently Asked Questions for PPO

If you move out of the area, this product enables you to continue to access participating PPO providers through the BlueCard® program. Through the BlueCard Program, the same advantages are provided to members who live, work, or travel outside of the PPO/PPN service area. This is done by utilizing the Blue Cross Blue Shield national network.

The BlueCard participating providers have agreements to accept our payment (after the member's coinsurance and deductible) as payment in full. 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 (2583) to obtain names of participating preferred providers in the area. This number is printed on the back of the ID Card.

Out-of-network services are available subject to an individual deductible of $250; family $500 and paid at 70% allowed benefit.

This product enables you to continue to access participating PPO providers through the BlueCard® program. Through the BlueCard Program, the same advantages are provided to members who live, work, or travel outside of the PPO/PPN service area. This is done by utilizing the Blue Cross Blue Shield national network.

Benefits are available for covered services given by in-network practitioners that participate with another Blue Cross and Blue Shield (BCBS) plan. The BlueCard® program puts you in touch with local participating network providers. Call BlueCard Access at 800-810-BLUE for the list of preferred providers.

Simply show your Member ID card and the hospital or doctor can submit the claims.

Out-of-network services are available subject to an individual deductible of $250; family $500 and paid at 70% allowed benefit.

Your State of Maryland PPO 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, vision and mental and behavioral health 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 access 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.

Many providers have a special agreement with CareFirst. These providers are called participating providers or in-network providers. If a member chooses a participating provider, the cost to the member is lower than if the member chooses a non-participating or out-of-network provider.

Yes, when benefits are obtained by an out-of-network provider they are subject to a $250 individual or $500 family deductible and paid at 70% allowed benefit. Member will be balance billed.

First, check to see if your physician participates with CareFirst BlueCross BlueShield. You may choose to get care from a physician who is not in the network. You must meet a deductible and pay coinsurance, and your coinsurance may be higher because these providers are not in the Preferred Provider network.

If your physician does not participate with CareFirst, you are responsible for direct payment to the provider, as well as your deductible and coinsurance.

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.

Benefits are available for covered services given by network practitioners that participate with another BlueCross and BlueShield (BCBS) plan. The BlueCard program puts you in touch with these local network providers. Call BlueCard Access at 800-810-BLUE or visit the BlueCard website for a list of participating providers.

Benefits are covered for services rendered by practitioners that 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 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.

You will receive the highest level of benefits for emergency care.

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.