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Health Benet Options 2021ActivesANNE ARUNDEL COUNTY PUBLIC SCHOOLS
ContentsWelcome ....................................1Take the Call.................................2Know Before You Go..........................4Patient-Centered Medical Home................6Away From Home Care ......................7BlueCard & Blue Cross Blue Shield Global® Core ..8Medical Benets Options .....................10Find Providers and Estimate Treatment Costs ...14Active Units 1–4 Pharmacy Program Summaryof Benets ........................15Active Units 5 & 6 Pharmacy Program Summary of Benets ........................17Specialty Pharmacy CoordinationProgram......19Ways to Save with Generic Drugs . . . . . . . . . . . . . .20Mail Service Pharmacy .......................22BlueChoice HMO Open Access Low Option Plan ............................23Low Option Plan Pharmacy Program Summaryof Benets ........................25Preferred Dental ............................27Traditional Dental ...........................28Dental Options..............................29Vision Program .............................30BlueVision (Davis Vision)......................32My Account .................................34Mental Health Support .......................36Health & Wellness ...........................37Preventive Service Guidelines for Adults ........39Preventive Service Guidelines for Children ......41Notice of Nondiscrimination and Availability ofLanguage Assistance Services.....43
Anne Arundel County Public Schools—Health Benet Options ■1WelcomeWelcome to your plan forhealthy livingFrom preventive services to maintaining your health, to our extensive network of providers and resources, CareFirst BlueCross BlueShield and CareFirst BlueChoice,Inc. (CareFirst) are there when you need care. We will work together to help you get well, stay well and achieve any wellness goals you have in mind.We know that health insurance is one of the most important decisions you make for you and your family—and we thank you for choosing CareFirst. This guide will help you understand your plan benets and all the services available to you as a CareFirst member.Please keep and refer to this guide while you are enrolled in this plan.How your plan worksFind out how your health plan works and how you can access the highest level of coverage.What’s coveredSee how your benets are paid, including any deductibles, copayments or coinsurance amounts that may apply to your plan.Getting the most out of your planTake advantage of the added features you have as a CareFirst member: Wellness discount program oering discounts on tness gear, gym memberships, healthy eating options and more. Online access to quickly nd a doctor or search for benets and claims. Health information on our website includes health calculators, tracking tools and podcast videos on specic health topics. Vitality magazine with healthy recipes, preventive health care tips and a variety of articles.Visit carerst.com/aacps for up-to-date information on your plan.SUM1816-1P (8/19)_C
■ Anne Arundel County Public Schools—Health Benet Options2 Take the CallYou know that CareFirst BlueCross BlueShield (CareFirst) provides your health benets and processes claims, but that’s not all we do. We’re there for you at every step of care—and every stage, even when life throws you a curveball.Whether you are faced with an unexpected medical emergency, managing a chronic condition like diabetes, or looking for help with a health goal such as losing weight, we oer one-on-one coaching and support programs. You may receive a letter or postcard in the mail, or a call from a nurse, health coach or pharmacy technician explaining the programs and inviting you to participate. These programs are condential and part of your medical benet. They can also play a huge role in helping you through an illness or keeping you healthy. Once you decide to participate, you can choose how involved you want to be. We encourage you to connect with the CareFirst team so you can take advantage of this personal support.PharmacyHealth & WellnessBehavioral HealthCareFirst may call you to offer one-on-one supportprograms concerning Health & Wellness, Complex Care Coordination, Pharmacy or Behavioral HealthComplex Care Coordinationcarerst.com/aacps
Anne Arundel County Public Schools—Health Benet Options ■3Take the CallHere are a few examples of when we may contact you about these programs. Visit carerst.com/aacps to learn more.Program name Overview Why it’s important CommunicationHealth & Wellness Personal coaching support to help you achieve your health goalsHealth coaching can help you manage stress, eat healthier, quit smoking, lose weight and much moreLetter or phone call from a Sharecare coachComplex Care CoordinationSupport for a variety of critical health concerns or chronic conditionsConnecting you with a nurse who works closely with your primary care provider (PCP) to help you understand your doctor’s recommendations, medications and treatment plansIntroduction by your PCP or a phone call from a CareFirst care coordinator (nurse)Hospital Transition of CareSupporting transition from hospital to homeHelp plan for your recovery after you leave the hospital, answer your questions and, based on your needs, connect you to additional services Onsite visit or phone call from a CareFirst nursePharmacy Advisor Managing medications for specic conditionsUnderstanding your condition and staying on track with appropriate medications is crucial to successfully managing your healthLetter or a phone call from a CVS Caremark pharmacy specialistComprehensive Medication ReviewManaging multiple medicationsTalking to a pharmacist who understands your medication history can help identify any possible side eects or harmful interactionsPhone call from a CVS Caremark pharmacistSpecialty Pharmacy CoordinationManaging specialty medications for chronic conditionsConnecting with a nurse who specializes in your condition provides additional support so you can adhere to your treatment plan for better healthLetter or phone call from a CVS Caremark specialty nurseBehavioral Health and Substance Use DisorderSupport for mental health and/or addiction issuesCondential, one-on-one support to help schedule appointments, explain treatment options, collaborate with doctors and identify additional resourcesPhone call from a CareFirst behavioral health care coordinatorThis wellness program is administered by Sharecare, Inc., an independent company that provides health improvement management services to CareFirst members. Sharecare, Inc. does not provide CareFirst BlueCross BlueShield products or services and is solely responsible for the health improvement management services it provides.CVS Caremark is an independent company that provides pharmacy benet management services to CareFirst members. CVS Caremark does not provide CareFirst BlueCross BlueShield products or services and is solely responsible for the pharmacy benet management services itprovides.SUM4110-1P (3/19)_C
■ Anne Arundel County Public Schools—Health Benet Options4 Know Before You GoYour money, your health, your decisionChoosing 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.*Primary care provider (PCP)The best place to get consistent, quality health care is your primary care provider (PCP). If you have a medical issue, having a doctor who knows your health history often makes it easier to get the care you need. 24-Hour Nurse Advice LineRegistered nurses are available 24/7 to discuss your symptoms with you and recommend the most appropriate care. Call 800-535-9700 anytime to speak with a nurse.CareFirst Video Visit When your PCP isn’t available and you need urgent care services, CareFirst Video Visit securely connects you with a doctor, day or night, through your smartphone, tablet or computer. In addition, you can schedule visits for other needs such as behavioral health support from a therapist or psychiatrist, guidance from a certied nutritionist or breastfeeding support from a lactation consultant. It’s a convenient and easy way to get the care you need, wherever you are. Visit carerstvideovisit.com to get started.Convenience care centers (retail health clinics)These are typically located inside a pharmacy or retail store (like CVS MinuteClinic or Walgreens Healthcare Clinic) and oer care for non-emergency situations like colds, pink eye, strep tests and vaccinations. These centers usually have evening and weekend hours.Urgent care centersUrgent care centers (such as Patient First or ExpressCare) provide treatment for injuries and illnesses that require prompt medical attention but are not life-threatening (sprains, minor cuts, u, rashes, minor burns). These centers have doctors on sta and oer weekend/after-hours care.Emergency room (ER)Emergency rooms treat acute illnesses and trauma. Go to the ER right away if you or a family member have sudden symptoms that need emergency care, including (but not limited to): chest pain, trouble breathing or head trauma. Prior authorization is not needed for emergency room services.For more information, visit carerst.com/aacps.*The medical providers mentioned in this document 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.
Anne Arundel County Public Schools—Health Benet Options ■5Know Before You GoWhen you need care When your PCP isn’t available, being familiar with your options will help you locate the most appropriate and cost-eective medical care. The chart below shows how costs* may vary for a sample health plan depending on where you choose to get care. Sample cost Sample symptoms Available 24/7 Prescriptions?Video Visit (urgent care services)$10Cough, cold and uPink eyeEar pain Convenience Care (e.g., CVS MinuteClinic or Walgreens Healthcare Clinic)$10Cough, cold and uPink eyeEar pain Urgent Care (e.g., Patient First or ExpressCare)$10SprainsCut requiring stitchesMinor burns Emergency Room $85Chest painDiculty breathingAbdominal pain 24-Hour Nurse Advice Line$0If 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.* The costs in this chart are for illustrative purposes only and may not represent your specic benets or costs.To determine your specic benets and associated costs: Log in to My Account at carerst.com/aacps; Check your Evidence of Coverage or benet summary; Ask your benet administrator; or Call Member Services at the telephone number on the back of your member ID card.For more information and frequently asked questions, visit carerst.com/aacps.Did you know that where you choose to get lab work, X-rays and surgical procedures can have a big impact on your wallet? Typically, services performed in a hospital cost more than non-hospital settings like LabCorp, Advanced Radiology or ambulatory surgery centers.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 oer medical advice. The choice of provider or place to seek medical treatment belongs entirely to you.SUM3119-1P (10/19)_C
■ Anne Arundel County Public Schools—Health Benet Options6 CST1310-1P (9/17)Patient-Centered Medical HomeSupporting the relationship between you and your doctorWhether 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). The program is designed to provide your PCP with a more complete view of your health needs. Your PCP will be able to use information to better manage and coordinate your care with all your health care providers including specialists, labs, pharmacies and others to ensure you get access to, and receive the most appropriate care in the most aordable settings. Extra care for certain health conditionsIf you have certain health conditions, your PCMH PCP will partner witha care coordinator, a registered nurse, to: Create a care plan based on your health needs with specic follow up activities Review your medications and possible drug interactions Check in with you to make sure you’re following your treatmentplan Assist you in obtaining services and equipment necessary to manage your health condition(s)A PCP is important to yourhealth By visiting your PCP for routine visits, you build a relationship, and your PCP will get to know you and your medical history. If you have an urgent health issue, having a PCP who knows your history often makes it easier and faster to get the care you need. Even if you are young and healthy, or don’t visit the doctor often, choosing a PCP is key to maintaining good health. 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 nd 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.
Anne Arundel County Public Schools—Health Benet Options ■7Away From Home Care Your HMO coverage goes with you®We’ve got you covered when you’re away from home for 90 consecutive days or more. Whether you’re out-of-town on extended business, traveling, or going to school out-of-state, you have access to routine and urgent care with our Away From Home Care program.Coverage while you’re awayYou’re covered when you see a provider of an aliated Blue Cross Blue Shield HMO (Host HMO) outside of the CareFirst BlueChoice, Inc. service area (Maryland, Washington, D.C. and Northern Virginia). If you receive care, then you’re considered a member of that Host HMO receiving the benets under that plan. So your copays may be dierent than when you’re in the CareFirst BlueChoice service area. You’ll be responsible for any copays under that plan. Enrolling in Away From HomeCareTo make sure you and your covered dependents have ongoing access to care: Call the Member Service phone number on your ID card and ask for the Away From Home Care Coordinator. The coordinator will let you know the name of the Host HMO in the area. If there are no participating aliated HMOs in the area, the program will not be available to you. The coordinator will help you choose a primary care physician (PCP) and complete the application. Once completed, the coordinator will send you the application to sign and date. Once the application is returned, we will send it to your Host HMO. Always remember to carry your ID card to access Away From Home Care. The Host HMO will send you a new, temporary ID card which will identify your PCP and information on how to access your benets while using Away From Home Care. Complete these steps annually as long as Away From Home Care benets are needed. Simply call your Host HMO primary care physician for an appointment when you need care.No paperwork or upfront costsOnce you are enrolled in the program and receive care, you don’t have to complete claim forms, so there is no paperwork. And you’re only responsible for out-of-pocket expenses such as copays, deductibles, coinsurance and the cost of non-covered services.BRC6389-1P (8/17)_C
■ Anne Arundel County Public Schools—Health Benet Options8 BlueCard & Blue Cross Blue Shield Global® CoreWherever you go, your health care coverage goes with youWith your Blue Cross and Blue Shield member ID card, you have access to doctors and hospitals almost anywhere. BlueCard gives you the peace of mind that you’ll always have the care you need when you’re away from home, from coast to coast. And with Blue Cross BlueShield Global® Core (BCBS Global® Core) you have access to care outside of the U.S.Your membership gives you a world of choices. More than 93% of all doctors and hospitals throughout the U.S. contract with Blue Cross and Blue Shield plans. Whether you need care here in the United States or abroad, you’ll have access to health care in more than 190 countries.When you’re outside of the CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. service area (Maryland, Washington, D.C., and Northern Virginia), you’ll have access to the local Blue Cross Blue Shield Plan and their negotiated rates with doctors and hospitals in that area. You shouldn’t have to pay any amount above these negotiated rates. Also, you shouldn’t have to complete a claim form or pay up front for your health care services, except for those out-of-pocket expenses (like non-covered services, deductibles, copayments, and coinsurance) that you’d pay anyway.Within the U.S.1. Always carry your current member ID card for easy reference and access to service.2. To nd names and addresses of nearby doctors and hospitals, visit the National Doctor and Hospital Finder at www.bcbs.com, or call BlueCard Access at 800-810-BLUE (2583).3. Call the Customer Service number on the back of your member ID card to verify benets or nd out if pre-certication or prior authorization is required.4. When you arrive at the participating doctor’s oce or hospital, simply present your ID card.5. After you receive care, you shouldn’t have to complete any claim forms or have to pay up front for medical services other than the usual out-of-pocket expenses. CareFirst will send you a complete explanation of benets.As always, go directly to the nearest hospital in an emergency.
Anne Arundel County Public Schools—Health Benet Options ■9BlueCard and Blue Cross Blue Shield Global® CoreAround the worldLike your passport, you should always carry your ID card when you travel or live outside the U.S. The Blue Cross Blue Shield Global® Core program (BCBS Global® Core) provides medical assistance services and access to doctors, hospitals and other health care professionals around the world. Follow the same process as if you were in the U.S. with the following exceptions: At hospitals in the BCBS Global Core Network, you shouldn’t have to pay up front for inpatient care, in most cases. You’re responsible for the usual out-of-pocket expenses. And, the hospital should submit your claim. At hospitals outside the BCBS Global Core Network, you pay the doctor or hospital for inpatient care, outpatient hospital care, and other medical services. Then, complete an international claim form and send it to the BCBS Global Core Service Center. The claim form is available online at bcbs.globalcore.com. To nd a BlueCard provider outside of the U.S. visit bcbs.com, select Find a Doctor or Hospital.Members of Maryland Small Group Reform (MSGR) groups have access to emergency coverage only outside of the U.S.Medical assistance when outsidetheU.S.Call 800-810-BLUE (2583) toll-free or 804-673-1177, 24hoursaday, 7daysaweek for information on doctors, hospitals, other health care professionals or to receive medical assistance services. A medical assistance coordinator, in conjunction with a medical professional, will make an appointment with a doctor or arrange hospitalization ifnecessary.Visit bcbs.com to nd providers within the U.S. and around the world.BRC6290-1P (6/19)
■ Anne Arundel County Public Schools—Health Benet Options10 Medical Benets OptionsActives—January 2021Product Line HMOProduct Name BlueChoice HMO Open AccessServicesNETWORK BLUECHOICECOPAYS$10 PCP / $15 Specialist copayANNUAL DEDUCTIBLEIndividual NoneFamily NoneANNUAL OUT-OF-POCKET MAXIMUMMedical $2,000 Ind. / $6,000 FamilyCombined Medical and Prescription Drug$6,350 Ind. / $12,700 FamilyLIFETIME MAXIMUM BENEFITUnlimited except on fertility servicesPREVENTIVE SERVICESWell-Child Care0–24 months No charge24 months–13 years (immunization visit)No charge24 months–13 years (non-immunization visit)No charge14–17 years No chargeAdult Physical Examination No chargeRoutine GYN Visits No chargeMammograms No chargeCancer Screening (Pap Test, Prostate and Colorectal)No chargeOFFICE VISITS, LABS AND TESTINGOce Visits for Illness $10 PCP / $15 Specialist copayDiagnostic Services $10 PCP / $15 Specialist copayX-ray and Lab Tests No copay (LabCorp)Allergy Testing $10 PCP / $15 Specialist copay (if oce visit copay paid, additional copay not required)Allergy Shots $10 PCP / $15 Specialist copay (if oce visit copay paid, additional copay not required)Outpatient Physical, Speech and Occupational Therapy (Oce Setting) $15 copay; (limited to 30 visits combined/condition/benet period)Outpatient Chiropractic $15 copay; (limited to 20 visits/condition/benet period)EMERGENCY CARE AND URGENT CAREPhysician’s Oce $10 PCP / $15 Specialist copayUrgent Care Center $10 PCP / $15 Specialist copayHospital Emergency Room $85 copay (waived if admitted)Ambulance (if medically necessary) 100% of AB
Anne Arundel County Public Schools—Health Benet Options ■11Medical Benets OptionsAB=Allowed BenetBlueChoice Triple Option Plan—Open Access—3 Health Care Plans in 1BlueChoice Triple Option Open AccessLevel 1 No Referrals RequiredLevel 2 No Referrals Required Level 3 No Referrals RequiredBLUECHOICE PREFERRED PROVIDER (PPO BLUE CARD)PARTICIPATING/ NON-PARTICIPATING$10 PCP/$10 Specialist $15 PCP/$15 Specialist N/ANone $200 $300 None $400 $600 $2,000 Ind. / $6,000 Family $2,000 Ind. / $6,000 Family $2,000 Ind. / $6,000 Family$6,350 Ind. / $12,700 Family $6,350 Ind. / $12,700 Family $6,350 Ind. / $12,700 FamilyUnlimited except on fertility servicesNo charge No charge 80% AB, no deductibleNo charge No charge 80% AB, no deductibleNo charge No charge 80% AB, no deductibleNo charge No charge 80% AB, no deductibleNo charge No charge 80% AB after deductibleNo charge No charge 80% AB after deductibleNo charge No charge 80% AB after deductibleNo charge No charge 80% AB after deductible$10 copay $15 copay 80% AB after deductible$10 copay $15 copay 80% AB after deductibleNo copay (LabCorp) $15 copay 80% AB after deductible$10 copay $15 copay 80% AB after deductible$10 copay $15 copay 80% AB after deductible$10 copay (limited to 30 visits combined per condition per year)$15 copay (limited to 100 visits per year, combined between Level 2 and 3)80% AB after deductible (limited to 100 visits per year, combined between Level 2 and 3)$10 copay (limited to 20 visits per year) $15 copay (unlimited visits) 80% AB after deductible (unlimited visits)$10 copay $15 copay 80% AB after deductible$10 copay $15 copay 80% AB after deductible$85 copay (waived if admitted) Considered under Level 1. If benets are not available under Level 1, benets may be payable under the appropriate levelConsidered under Level 1. If benets are not available under Level 1, benets may be payable under the appropriate level. 100% of Allowed Benet Considered under Level 1. If benets are not available under Level 1, benets may be payable under the appropriate levelConsidered under Level 1. If benets are not available under Level 1, benets may be payable under the appropriate level.
■ Anne Arundel County Public Schools—Health Benet Options12 Medical Benets OptionsAB=Allowed BenetProduct Line HMOProduct Name BlueChoice HMO Open AccessServicesHOSPITALIZATIONInpatient Facility Services No chargeOutpatient Facility Services No chargeInpatient Physician Services No chargeOutpatient Physician Services $10 PCP / $15 Specialist copayHOSPITAL ALTERNATIVESHome Health Care No charge Hospice No charge Skilled Nursing Facility (limited to 365 days/benet period)No chargeMATERNITYPreventive Prenatal and Postnatal Oce VisitsNo chargeDelivery and Facility Services No chargeNursery Care of Newborn No charge Articial Insemination—Subject to State Mandate (limited to 6 attempts per live birth)50% of the AB InVitro Fertilization Procedures—Subject to State Mandate (limited to 3 attempts per live birth & $100,000 lifetime max)50% of the AB MENTAL HEALTH (MH) AND SUBSTANCE USE DISORDER (SUD)—SUBJECT TO FEDERAL MANDATEInpatient Facility Services (requires Pre-authorization)No charge Inpatient Physician Services No chargeOutpatient Services (MH & SUD) $10 copay (oce)Partial Hospitalization No chargeMedication Management Visit $10 copay MISCELLANEOUSDurable Medical Equipment No charge Diabetic Supplies Covered under Prescription Drug planAcupuncture $15 copay (limited to 24 visits/benet period)Hearing Aids for Children and Adults (limited to one hearing aid/per ear every 36 months)100% AB per aid/per ear; member may be balanced billed up to the total chargeOutpatient Surgery (oce) $10 PCP / $15 Specialist copayChemotherapy/Radiation Therapy (oce)$15 copayRenal Dialysis No chargeCardiac Rehab (subject to Medical Policy review)No chargeDEPENDENT AGE LIMITTo age 26, end of month
Anne Arundel County Public Schools—Health Benet Options ■13Medical Benets OptionsBlueChoice Triple Option Plan—Open Access—3 Health Care Plans in 1BlueChoice Triple Option Open AccessLevel 1 No Referrals RequiredLevel 2 No Referrals Required Level 3 No Referrals RequiredNo charge 90% AB after deductible 80% AB after deductibleNo charge 90% AB after deductible 80% AB after deductibleNo charge 90% AB after deductible 80% AB after deductible$10 copay $15 copay 80% AB after deductibleNo charge 100% AB 100% ABNo charge 100% AB 100% ABNo charge 90% AB after deductible 80% AB after deductibleNo charge No charge 80% AB after deductibleNo charge 90% AB after deductible 80% AB after deductibleNo charge 90% AB after deductible 80% AB after deductibleNot covered under Level 1 90% AB after deductible (OP Facility) $15 copay (OP Facility Practitioner or Oce)80% AB after deductible Not covered under Level 1 90% AB after deductible (OP Facility) $15 copay (OP Facility Practitioner or Oce)80% AB after deductible BLUECHOICE NETWORK PREFERRED PROVIDER NETWORKPARTICIPATING/ NON-PARTICIPATINGNo charge 90% AB after deductible 80% AB after deductibleNo charge 90% AB after deductible 80% AB after deductible$10 copay $10 copay 80% AB after deductibleNo charge 100% AB 80% AB after deductible$10 copay $10 copay 80% AB after deductibleNo charge 90% AB after deductible 80% AB after deductibleCovered under Prescription Drug plan$10 copay (limited to 24 visits/benet period) $15 copay 80% AB after deductible100% AB per aid/per ear; member may be balanced billed up to the total charge$10 copay $15 copay 80% AB after deductible$10 copay $15 copay 80% AB after deductibleNo charge $15 copay 80% AB after deductibleNo charge 100% AB 80% AB after deductibleTo age 26, end of month To age 26, end of month To age 26, end of month
■ Anne Arundel County Public Schools—Health Benet Options14 Find Providers and Estimate Treatment CostsFind providerscarerst.com/aacpsYou can easily nd health care providers and facilities that participate with your CareFirst health plan. Search for and lter results based on your specic needs, like: Provider name Provider specialty Distance Gender Accepting new patients Language Group aliationsReview providersRead what other members are saying about the providers you’re considering before making an appointment. You can also leave feedback of your own after your visit.Make low-cost, high-quality decisionsWhen you need a medical procedure, there are other things to worry about besides your out-of-pocket costs. To help you make the best care decisions for your needs, CareFirst’s Treatment Cost Estimator will: Quickly estimate your total treatment costs Avoid surprises and save money Plan ahead to control expensesWant to see how it works? Visit carerst.com/aacps today!Quickly nd doctors and facilities, review your health providers and estimate treatment costs—all in one place!Want to view personalized information about doctors in your plan’s network? Be sure to log in to My Account from your computer, tablet or smartphone.CUT5766-2P (8/19)_C
Anne Arundel County Public Schools—Health Benet Options ■15Active Units 1–4 Pharmacy Program Summary of BenetsFormulary 2 5-Tier $0 Deductible $5/20/35 Specialty 50%/50% Plan Feature Amount You Pay DescriptionIndividual Deductible None Your benet does not have a deductible.Family Deductible None Your benet does not have a family deductible.Out-of-Pocket Maximum Individual: $6,350Family: $12,700If you reach your out-of-pocket maximum, CareFirst or CareFirst BlueChoice will pay 100% of the applicable allowed benet for most covered services for the remainder of the year. All deductibles, copays, coinsurance and other eligible out-of-pocket costs count toward your out-of-pocket maximum, except balance billed amounts.Preventive Drugs (up to a 30-day supply)$0 A preventive drug is a prescribed medication or item on CareFirst’s Preventive Drug List.* Generic Drugs (Tier 1) (up to a 30-day supply)$5 Generic drugs are covered at this copay level.Preferred Brand Drugs (Tier 2) (up to a 30-day supply)$20 All preferred brand drugs are covered at this copay level.Non-preferred Brand Drugs (Tier 3) (up to a 30-day supply)$35 All non-preferred brand drugs on this copay level are not on the Preferred Drug List.* Discuss using alternatives with your physician or pharmacist.Preferred Specialty Drugs (Tier 4)(up to a 30-day supply)50% up to a $75 maximum You pay 50% coinsurance up to a maximum of $75 for all preferred specialty drugs. Must be lled through Exclusive Specialty Pharmacy Network.Non-preferred Specialty Drugs (Tier 5)(up to a 30-day supply)50% up to a $75 maximum You pay 50% coinsurance up to a maximum of $75 for all non-preferred specialty drugs. Must be lled through Exclusive Specialty Pharmacy Network.Maintenance Drugs (up to a 90-day supply)Generic: $10 Preferred Brand: $40 Non-preferred Brand: $70 Preferred Specialty: 50% up to a $150 maximum Non-preferred Specialty: 50%up to a $150 maximumMaintenance generic, preferred brand and non-preferred brand drugs up to a 90-day supply are available for twice the copay through Maintenance Choice at a CVS retail pharmacy or through Mail Service Pharmacy. Maintenance preferred and non-preferred specialty drugs up to a 90-day supply must be lled through Exclusive Specialty Pharmacy Network and you pay 50% coinsurance up to a maximum copay.Rell Limit One initial ll plus one rell for long term medications at a retail pharmacyBefore you reach your 30-day ll limit and your out-of-pocket cost increases, we will contact you to help you get started with Maintenance Choice. We’ll then help you get a 90-day prescription from your doctor so you can choose to ll it through Mail Service or at a CVS retail pharmacy.Restricted Generic SubstitutionIf a provider prescribes a non-preferred brand drug when a generic is available, you will pay the non-preferred brand copay or coinsurance PLUS the cost dierence between the generic and brand drug up to the cost of the prescription. If a generic version is not available, you will only pay the copay or coinsurance. Also, if your prescription is written for a brand-name drug and DAW (dispense as written) is noted by your doctor, you will only pay the copay or coinsurance. Visit carerst.com/aacps for the most up-to-date drug lists, including the prescription guidelines. Prescription guidelines indicate drugs that require your doctor to obtain prior authorization from CareFirst before they can be lled and drugs that can be lled in limited quantities.This plan summary is for comparison purposes only and does not create rights not given through the benet plan.Policy Form Numbers: MD/CFBC/RX (R. 1/18) • CFMI/RX (R. 1/18) • CFMI/Matrix/PRESC DRUG (R. 1/18) • MD/CF/RX (R. 1/18)
■ Anne Arundel County Public Schools—Health Benet Options16 Active Units 1–4 Pharmacy Program Summary of BenetsCST3765-1P (9/17)_CFill your maintenance drug prescriptions with Maintenance ChoiceMaintenance Choice oers you options and savings when it comes to lling your maintenance medications. Maintenance medications are drugs taken regularly for an ongoing condition such as high blood pressure, diabetes, etc. With Maintenance Choice, you can get up to a three-month supply of your maintenance drugs for the cost of a two-month supply. There are two ways to save when lling your maintenance drug prescriptions. CVS Mail Service Pharmacy Enjoy convenient home delivery service Rell your prescriptions online, by phone oremail Check account balances and make payments through an automated phone system Sign up to receive email notications of order status Access a consulting pharmacist by phone 24hours a dayCVS Retail Pharmacy Access the entire network of CVS pharmacies Pick up your medications at a time convenient to you Enjoy same-day prescription availability Talk with a pharmacist face-to-faceYou will be allowed to ll a one-month prescription two times at any retail pharmacy as we transition to Maintenance Choice. Before you reach your ll limit, CVS/caremark* will contact you to help you get started with Maintenance Choice. We’ll then help you get a new prescription from your doctor so you can choose to ll it through CVS Mail Service Pharmacy or at a CVS retail pharmacy. For more information, call us toll-free at 800-241-3371.If you would like… Then…To pick up at a CVS retail pharmacy or register for CVSMail Service PharmacyPlease let us know.You can do so quickly and easily. Choose the option that works best for you: Go to www.carerst.com/aacps and log into My Account from your computer, tablet or smartphone. Click on My Coverage, select Drug and Pharmacy Resources, select My Drug Home and Order Prescriptions to select a CVS pharmacy location for pick up or register for CVS Mail Service Pharmacy. Visit your local CVS retail pharmacy and talk to the pharmacist Call us toll-free using the number on the back of your member ID card, and we’ll handle the restTo continue with CVS Mail Service PharmacyYou don’t have to do anything.We’ll continue to send your medications to your location of choice.*CVS/caremark is an independent company that provides pharmacy benet management services.
Anne Arundel County Public Schools—Health Benet Options ■17Active Units 5 & 6 Pharmacy Program Summary of BenetsFormulary 2 5-Tier $0 Deductible $5/20/35 Specialty $75/$75 Plan Feature Amount You Pay DescriptionIndividual Deductible None Your benet does not have a deductible.Family Deductible None Your benet does not have a family deductible.Out-of-Pocket Maximum Individual: $6,350Family: $12,700If you reach your out-of-pocket maximum, CareFirst or CareFirst BlueChoice will pay 100% of the applicable allowed benet for most covered services for the remainder of the year. All deductibles, copays, coinsurance and other eligible out-of-pocket costs count toward your out-of-pocket maximum, except balance billed amounts.Preventive Drugs (up to a 30-day supply)$0 A preventive drug is a prescribed medication or item on CareFirst’s Preventive Drug List.* Generic Drugs (Tier 1) (up to a 30-day supply)$5 Generic drugs are covered at this copay level.Preferred Brand Drugs (Tier 2) (up to a 30-day supply)$20 All preferred brand drugs are covered at this copay level.Non-preferred Brand Drugs (Tier 3) (up to a 30-day supply)$35 All non-preferred brand drugs on this copay level are not on the Preferred Drug List.* Discuss using alternatives with your physician or pharmacist.Preferred Specialty Drugs (Tier 4)(up to a 30-day supply)$75 You pay $75 for all preferred specialty drugs. Must be lled through Exclusive Specialty Pharmacy Network.Non-preferred Specialty Drugs (Tier 5)(up to a 30-day supply)$75 You pay $75 for all non-preferred specialty drugs. Must be lled through Exclusive Specialty Pharmacy Network.Maintenance Drugs (up to a 90-day supply)Generic: $10 Preferred Brand: $40 Non-preferred Brand: $70 Preferred Specialty: $150Non-preferred Specialty: $150Maintenance generic, preferred brand and non-preferred brand drugs up to a 90-day supply are available for twice the copay through Maintenance Choice at a CVS retail pharmacy or through Mail Service Pharmacy. Maintenance preferred and non-preferred specialty drugs up to a 90-day supply must be lled through Exclusive Specialty Pharmacy Network and you pay 50% coinsurance up to a maximum copay.Rell Limit One initial ll plus one rell for long term medications at a retail pharmacyBefore you reach your 30-day ll limit and your out-of-pocket cost increases, we will contact you to help you get started with Maintenance Choice. We’ll then help you get a 90-day prescription from your doctor so you can choose to ll it through Mail Service or at a CVS retail pharmacy.Restricted Generic SubstitutionIf a provider prescribes a non-preferred brand drug when a generic is available, you will pay the non-preferred brand copay or coinsurance PLUS the cost dierence between the generic and brand drug up to the cost of the prescription. If a generic version is not available, you will only pay the copay or coinsurance. Also, if your prescription is written for a brand-name drug and DAW (dispense as written) is noted by your doctor, you will only pay the copay or coinsurance. Visit carerst.com/aacps for the most up-to-date drug lists, including the prescription guidelines. Prescription guidelines indicate drugs that require your doctor to obtain prior authorization from CareFirst before they can be lled and drugs that can be lled in limited quantities.This plan summary is for comparison purposes only and does not create rights not given through the benet plan.Policy Form Numbers: MD/CFBC/RX (R. 1/18) • CFMI/RX (R. 1/18) • CFMI/Matrix/PRESC DRUG (R. 1/18) • MD/CF/RX (R. 1/18)
■ Anne Arundel County Public Schools—Health Benet Options18 Active Units 5 & 6 Pharmacy Program Summary of BenetsCST3455-1P (9/17) _CFill your maintenance drug prescriptions with Maintenance ChoiceMaintenance Choice oers you options and savings when it comes to lling your maintenance medications. Maintenance medications are drugs taken regularly for an ongoing condition such as high blood pressure, diabetes, etc. With Maintenance Choice, you can get up to a three-month supply of your maintenance drugs for the cost of a two-month supply. There are two ways to save when lling your maintenance drug prescriptions. CVS Mail Service Pharmacy Enjoy convenient home delivery service Rell your prescriptions online, by phone oremail Check account balances and make payments through an automated phone system Sign up to receive email notications of order status Access a consulting pharmacist by phone 24hours a dayIf you would like… Then…To pick up at a CVS retail pharmacy or register for CVSMail Service PharmacyPlease let us know.You can do so quickly and easily. Choose the option that works best for you: Go to www.carerst.com/aacps and log into My Account from your computer, tablet or smartphone. Click on My Coverage, select Drug and Pharmacy Resources, select My Drug Home and Order Prescriptions to select a CVS pharmacy location for pick up or register for CVS Mail Service Pharmacy. Visit your local CVS retail pharmacy and talk to the pharmacist Call us toll-free using the number on the back of your member ID card, and we’ll handle the restTo continue with CVS Mail Service PharmacyYou don’t have to do anything.We’ll continue to send your medications to your location of choice.*CVS/caremark is an independent company that provides pharmacy benet management services.CVS Retail Pharmacy Access the entire network of CVS pharmacies Pick up your medications at a time convenient to you Enjoy same-day prescription availability Talk with a pharmacist face-to-faceYou will be allowed to ll a one-month prescription two times at any retail pharmacy as we transition to Maintenance Choice. Before you reach your ll limit, CVS/caremark* will contact you to help you get started with Maintenance Choice. We’ll then help you get a new prescription from your doctor so you can choose to ll it through CVS Mail Service Pharmacy or at a CVS retail pharmacy. For more information, call us toll-free at 800-241-3371.
Anne Arundel County Public Schools—Health Benet Options ■19SUM2653-1P (11/19) Not applicable to VA risk plans For Non-risk: all jurisdictions; all plansSpecialty Pharmacy Coordination ProgramPersonalized support, and services for managing complex healthconditions As costly as specialty drugs can be, the outcomes can dramatically improve the quality of your life. Yet, the eectiveness of your medications depends mostly on whether you are taking them as prescribed. The Specialty Pharmacy Coordination Program provides specialty drug management by coordinating your care as part of a comprehensive plan monitored closely by qualied professionals. Selecting the right pharmacy within a network is an important way to avoid breakdowns and improve consistency of your care. CVS Specialty Pharmacy can ship specialty drugs to your home or to a retail CVS Pharmacy for you to pick up.To help you achieve the best possible health outcomes, the following services are available: One-on-one support from a registered nurse specializing in your specic condition Comprehensive assessment when you start the program Dedicated clinical team who coordinates care with your doctor Drug interaction review Drug and condition-specic education and counseling on medication adherence, side eects and safety Rell reminders 24-hour pharmacist assistanceThe program addresses the unique clinical needs for the following conditions: Crohn’sDisease, Cystic Fibrosis, Hemophilia, Hereditary Angioedema, Multiple Sclerosis, Oncology, Rheumatoid Arthritis, Ulcerative Colitis and select IVIG conditions.
■ Anne Arundel County Public Schools—Health Benet Options20 Ways to Save with Generic DrugsTake control & save on your drug costsYou can save money on prescription drugs by switching to generics. Generic drugs are proven to be just as safe and eective as their brand-name counterparts. The dierence? Name and price. What are generics? Generics work the same as brand-name drugs, but cost much less. A generic drug is essentially a copy of a brand-name drug. It contains the same active ingredients and is identical in dosage, safety, strength, how it’s taken, quality, performance and intended use. Generic drugs are approved by the U.S. Food and Drug Administration (FDA). Generic drugs are manufactured in facilities that are required to meet the same FDA standards of good manufacturing practices as brand-name products.1Save by using generic drugs Generic drugs are less expensive than brand-name medications. When multiple companies market a single approved product, market competition typically results in prices about 85% less than the brand-name drug.1 A study by the FDA concluded that consumers who are able to replace all their branded prescriptions with generics can save up to 52percent on their daily drug costs.2Here’s an example of how much you could save by switching to a generic alternative. Brand name Generic nameAverage monthly cost* of brandAverage monthly cost* of genericMonthly savings if using genericAmbien (10mg) Zolpidem Tartrate $474 $1 $473Coumadin (2mg) Warfarin Sodium $169 $8 $161Singulair (10mg) Montelukast Sodium $200 $6 $194*Costs based on CareFirst BlueCross BlueShield November 2015–April 2016 claims at CVS pharmacies and rounded to the nearest dollar.1 FDA, Generic Drug Facts, October 6, 2017, https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/GenericDrugs/ucm167991.htm2 FDA, Savings from Generic Drugs Purchased at Retail Pharmacies, May 6, 2016, https://www.fda.gov/drugs/resourcesforyou/ucm134205.htm.
Anne Arundel County Public Schools—Health Benet Options ■21Ways to Save with Generic DrugsSUM3129-1P (11/17)_C For self-insured groups onlyHow do I switch to a generic drug?You can ask your doctor or pharmacist if any of the prescription medications you are currently taking can be lled with a generic alternative. To nd out if there are lower cost drugs available, including generics, which can be used to treat your condition: Visit the Drug Search section on carerst.com/aacps and review the Preferred Drug List for your formulary. Print the list and take it with you to your doctor. Ask your doctor if a generic drug could work for you.How we help you saveTo help you get the most savings, our pharmacy benet manager, CVS Caremark* noties members by mail about opportunities to save with generic drugs. If you ll a prescription for a non-preferred brand drug you will receive a personalized letter from CVS Caremark with available lower-cost generic alternative options plus steps for changing to a generic alternative. Plus, a letter will be enclosed that you can take to your doctor on your next visit.*CVS Caremark is an independent company that provides pharmacy benet management services.
■ Anne Arundel County Public Schools—Health Benet Options22 BRC6500-1P (10/19)Mail Service PharmacyReliable. Fast. Convenient.Take advantage of CVS Caremark Mail Service Pharmacy, a fast and accurate home delivery service that oers a way for you to save both time and money on your long-term (maintenance) prescriptions.*As a CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc. (CareFirst) member, once you register for Mail Service Pharmacy you’ll be able to: Rell prescriptions online, by phone or byemail Schedule automatic rells Choose your delivery location Consult a pharmacist by phone 24/7 Receive email notication of order status Choose from multiple payment optionsIt’s easy to register for mail serviceChoose one of the following three ways:Online Go to carerst.com/myaccount and log in. Under the Coverage tab, select Drug and Pharmacy Resources, and select Request a New Mail Order Prescription. Once you’ve entered your prescription information, we will contact your doctor to request up to a 90-day supply of your medication.By phone Call the toll-free phone number on the back of your member ID card. Our Customer Care representatives can walk you through the process. By mail If you already have your prescription, you can send it to us with a completed Mail Service Pharmacy Order Form. Log in to My Account and select the Coverage tab, then choose Drug and Pharmacy Resources. Scroll to the bottom of the page and click on MyDrug Forms. Mailing instructions are included on the form.* Maintenance medications are used to treat chronic, long-term conditions, such as high blood pressure or diabetes, and are taken on a regular, recurring basis.
Anne Arundel County Public Schools—Health Benet Options ■23BlueChoice HMO Open Access Low Option PlanSummary of BenetsServices In-Network You Pay1Visit www.carerst.com/aacps to locate providersANNUAL DEDUCTIBLE (Benet period)2Individual $4,500Family $9,000ANNUAL OUT-OF-POCKET MAXIMUM (Benet period)3Medical4$6,350 Individual/$12,700 FamilyPrescription Drug4Combined with in-network medical out-of-pocket maximumLIFETIME MAXIMUM BENEFITLifetime Maximum NonePREVENTIVE SERVICESWell-Child Care (including exams & immunizations) No charge*Adult Physical Examination (including routine GYN visit)No charge*Breast Cancer Screening No charge*Pap TestNo charge*Prostate Cancer ScreeningNo charge*Colorectal Cancer Screening No charge*OFFICE VISITS, LABS AND TESTINGOce Visits for Illness Deductible, then $30 PCP/$40 Specialist per visitImaging (MRA/MRS, MRI, PET & CAT scans)5$40 per visitLab5$40 per visitX-ray5$40 per visitAllergy Testing $30 PCP/$40 Specialist per visitAllergy Shots $30 PCP/$40 Specialist per visitPhysical, Speech and Occupational Therapy (limited to 30 visits combined/injury/benet period)Deductible, then $40 per visitChiropractic (limited to 20 visits/benet period)Deductible, then $40 per visitAcupuncture Not covered (except when approved or authorized by Plan when used for anesthesia)EMERGENCY CARE AND URGENT CAREUrgent Care Center Deductible, then $100 per visitEmergency Room—Facility Services Deductible, then $300 per visit (waived if admitted)Emergency Room—Physician Services No charge* after deductibleAmbulance (if medically necessary) No charge* after deductibleHOSPITALIZATION—MEMBERS ARE RESPONSIBLE FOR APPLICABLE PHYSICIAN AND FACILITY FEESOutpatient Facility Services Deductible, then 30% of Allowed BenetOutpatient Physician Services Deductible, then 30% of Allowed BenetInpatient Facility Services Deductible, then 30% of Allowed BenetInpatient Physician Services Deductible, then 30% of Allowed BenetHOSPITAL ALTERNATIVESHome Health Care Deductible, then 30% of Allowed BenetHospice Deductible, then 30% of Allowed BenetSkilled Nursing Facility Deductible, then 30% of Allowed Benet
■ Anne Arundel County Public Schools—Health Benet Options24 BlueChoice HMO Open Access Low Option PlanCST2932-1P (9/17) MD Low Option PlanServices In-Network You Pay1MATERNITYPreventive Prenatal and Postnatal Oce Visits No charge*Delivery and Facility Services Deductible, then 30% of Allowed BenetNursery Care of Newborn Deductible, then 30% of Allowed BenetArticial and Intrauterine Insemination6(limited to 6 attempts per live birth)Deductible, then 50% of Allowed BenetIn Vitro Fertilization Procedures6(limited to 3 attempts per live birth up to $100,000 lifetime maximum)Deductible, then 50% of Allowed BenetMENTAL HEALTH AND SUBSTANCE USE DISORDERInpatient Facility Services Deductible, then 30% of Allowed BenetInpatient Physician Services Deductible, then 30% of Allowed BenetOutpatient Facility Services Deductible, then 30% of Allowed BenetOutpatient Physician Services Deductible, then 30% of Allowed BenetOce Visits Deductible, then $30 per visitMedication Management Deductible, then $30 per visitMEDICAL DEVICES AND SUPPLIESDurable Medical Equipment Deductible, then 50% of Allowed BenetHearing Aids for ages 0-18 (limited to 1 hearing aid per hearing impaired ear every 3 years)No charge*VISIONRoutine Exam (limited to 1 visit/benet period) $10 per visitEyeglasses and Contact Lenses Discounts from participating Vision CentersNote: Allowed Benet is the fee that providers in the network have agreed to accept for a particular service. The provider cannot charge the member more than this amount for any covered service. Example: Dr. Carson charges $100 to see a sick patient. To be part of CareFirst’s network, he has agreed to accept $50 for the visit. The member will pay their copay/coinsurance and deductible (if applicable) and CareFirst will pay the remaining amount up to $50.*No copayment or coinsurance.1When multiple services are rendered on the same day by more than one provider, Member payments are required for each provider.2For family coverage only: When one family member meets the individual deductible, they can start receiving benets as indicated above. Each family member cannot contribute more than the individual deductible amount. The family deductible must be met before the remaining family members can start receiving benets.3For Family coverage only: When one family member meets the individual out-of-pocket maximum, their services will be covered at 100% up to the Allowed Benet. Each family member cannot contribute more than the individual out-of-pocket maximum amount. The family out-of-pocket maximum must be met before the services for all remaining family members will be covered at 100% up to the Allowed Benet.4Plan has an integrated medical and prescription drug out-of-pocket maximum.5Members who reside in the CareFirst service area must use LabCorp as their Lab Test facility and freestanding facilities for Imaging and X-rays.6Members who are unable to conceive have coverage for the evaluation of infertility services performed to conrm an infertility diagnosis, and some treatment options for infertility. Preauthorization required.Note: Upon enrollment in CareFirst BlueChoice, you will need to select a Primary Care Provider (PCP). To select a PCP, go to www.carerst.com for the most current listing of PCPs from our online provider directory. You may also call the Member Services toll free phone number on the front of your CareFirst BlueChoice ID card for assistance in selecting a PCP or obtaining a printed copy of the CareFirst BlueChoice provider directory.Not all services and procedures are covered by your benets contract. This summary is for comparison purposes only and does not create rights not given through the benet plan.The benets described are issued under form numbers: MD/CFBC/GC (R. 1/13); MD/CFBC/EOC (R. 4/08); MD/CFBC/DOL APPEAL (R. 9/11); MD/CFBC/DOCS (R.4/08); MD/BC-OOP/SOB (R. 4/08); MD/CFBC/ELIG (R.7/09); MD/CFBC/RX (R. 7/12) and any amendments.
Anne Arundel County Public Schools—Health Benet Options ■25Low Option Plan Pharmacy Program Summary of BenetsFormulary 2 5-Tier Minimum Value $500 Deductible $15/35/60 Specialty 50%/50% Plan Feature Amount You Pay DescriptionIndividual Deductible $500 If you meet your deductible, you will pay a dierent copay or coinsurance depending on the drug tier. Drugs not subject to anydeductible are noted below.Family Deductible $1,000 If your family has met the deductible, all members will pay the copays associated with the drugs prescribed. No one family member may contribute more than the individual deductible amount to the family deductible.Out-of-Pocket Maximum Individual: $6,350Family: $12,700If you reach your out-of-pocket maximum, CareFirst or CareFirst BlueChoice will pay 100% of the applicable allowed benet for most covered services for the remainder of the year. All deductibles, copays, coinsurance and other eligible out-of-pocket costs count toward your out-of-pocket maximum, except balance billed amounts.Preventive Drugs (up to a 30-day supply)$0 (not subject to deductible)A preventive drug is a prescribed medication or item on CareFirst’s Preventive Drug List.* Generic Drugs (Tier 1) (up to a 30-day supply)$15 Generic drugs are covered at this copay level.Preferred Brand Drugs (Tier2) (up to a 30-day supply)$35 All preferred brand drugs are covered at this copay level.Non-preferred Brand Drugs (Tier 3) (up to a 30-day supply)$60 All non-preferred brand drugs on this copay level are not on the Preferred Drug List.* Discuss using alternatives with your physician or pharmacist.Preferred Specialty Drugs (Tier 4)(up to a 30-day supply)50% up to a $150 maximum You pay 50% coinsurance up to a maximum of $150 for all preferred specialty drugs. Must be lled through Exclusive Specialty Pharmacy Network.Non-preferred Specialty Drugs (Tier 5)(up to a 30-day supply)50% up to a $150 maximum You pay 50% coinsurance up to a maximum of $150 for all non-preferred specialty drugs. Must be lled through Exclusive Specialty Pharmacy Network.Maintenance Drugs (up to a 90-day supply)Generic: $30 Preferred Brand: $70 Non-preferred Brand: $120 Preferred Specialty: 50% up to a $300 maximum Non-preferred Specialty: 50%up to a $300 maximumMaintenance generic, preferred brand and non-preferred brand drugs up to a 90-day supply are available for twice the copay through Maintenance Choice at a CVS retail pharmacy or through Mail Service Pharmacy. Maintenance preferred and non-preferred specialty drugs up to a 90-day supply must be lled through Exclusive Specialty Pharmacy Network and you pay 50% coinsurance up to a maximum copay.Rell Limit One initial ll plus one rell for long term medications at a retail pharmacyBefore you reach your 30-day ll limit and your out-of-pocket cost increases, we will contact you to help you get started with Maintenance Choice. We’ll then help you get a 90-day prescription from your doctor so you can choose to ll it through Mail Service or at a CVS retail pharmacy.Restricted Generic SubstitutionIf a provider prescribes a non-preferred brand drug when a generic is available, you will pay the non-preferred brand copay or coinsurance PLUS the cost dierence between the generic and brand drug up to the cost of the prescription. If a generic version is not available, you will only pay the copay or coinsurance. Also, if your prescription is written for a brand-name drug and DAW (dispense as written) is noted by your doctor, you will only pay the copay or coinsurance. Visit carerst.com/aacps for the most up-to-date drug lists, including the prescription guidelines. Prescription guidelines indicate drugs that require your doctor to obtain prior authorization from CareFirst before they can be lled and drugs that can be lled in limited quantities.This plan summary is for comparison purposes only and does not create rights not given through the benet plan.Policy Form Numbers: MD/CFBC/RX (R. 1/18) • CFMI/RX (R. 1/18) • CFMI/Matrix/PRESC DRUG (R. 1/18) • MD/CF/RX (R. 1/18)
■ Anne Arundel County Public Schools—Health Benet Options26 Low Option Plan Pharmacy Program Summary of BenetsCST2931-1P (9/17) MD Low Option Plan_CFill your maintenance drug prescriptions with Maintenance ChoiceMaintenance Choice oers you options and savings when it comes to lling your maintenance medications. Maintenance medications are drugs taken regularly for an ongoing condition such as high blood pressure, diabetes, etc. With Maintenance Choice, you can get up to a three-month supply of your maintenance drugs for the cost of a two-month supply. There are two ways to save when lling your maintenance drug prescriptions. CVS Mail Service Pharmacy Enjoy convenient home delivery service Rell your prescriptions online, by phone oremail Check account balances and make payments through an automated phone system Sign up to receive email notications of order status Access a consulting pharmacist by phone 24hours a dayCVS Retail Pharmacy Access the entire network of CVS pharmacies Pick up your medications at a time convenient to you Enjoy same-day prescription availability Talk with a pharmacist face-to-faceYou will be allowed to ll a one-month prescription two times at any retail pharmacy as we transition to Maintenance Choice. Before you reach your ll limit, CVS/caremark* will contact you to help you get started with Maintenance Choice. We’ll then help you get a new prescription from your doctor so you can choose to ll it through CVS Mail Service Pharmacy or at a CVS retail pharmacy. For more information, call us toll-free at 800-241-3371.If you would like… Then…To pick up at a CVS retail pharmacy or register for CVSMail Service PharmacyPlease let us know.You can do so quickly and easily. Choose the option that works best for you: Go to www.carerst.com/aacps and log into My Account from your computer, tablet or smartphone. Click on My Coverage, select Drug and Pharmacy Resources, select My Drug Home and Order Prescriptions to select a CVS pharmacy location for pick up or register for CVS Mail Service Pharmacy. Visit your local CVS retail pharmacy and talk to the pharmacist Call us toll-free using the number on the back of your member ID card, and we’ll handle the restTo continue with CVS Mail Service PharmacyYou don’t have to do anything.We’ll continue to send your medications to your location of choice.*CVS/caremark is an independent company that provides pharmacy benet management services.
Anne Arundel County Public Schools—Health Benet Options ■27Preferred DentalIncludes access to a National Provider NetworkCareFirst BlueCross BlueShield (CareFirst) and CareFirst BlueChoice, Inc. (CareFirst BlueChoice)1 oer Preferred (PPO) Dental coverage, which allows you the freedom to see any dentist you choose.Advantages of the plan Freedom of choice, freedom to save—With Preferred Dental coverage, you can see any dentist you choose. However, this plan also gives you the option to reduce your out-of-pocket expenses by visiting a dentist who participates in our Preferred Provider network. It’s your choice! Comprehensive coverage—Benets include regular preventive care, X-rays, dental surgery and more. A summary of your benets is available on the following page. (Additional coverage for orthodontia is included for children and adults.) Nationwide access to participating dentists—You have access to one of the nation’s largest dental networks, with more than 95,000 participating dentists throughout the United States. Preferred Dental gives you coverage for the dental services you need, whenever and wherever you need them.Three options for care Option 1—By choosing a dentist in the Preferred Provider Network, you incur the lowest out-of-pocket costs. These dentists accept CareFirst’s allowed benet as payment in full, which means no balance billing for you. You are just responsible for deductibles and coinsurance. Option 2—You can receive out-of-network coverage from a dentist who participates with CareFirst, but not through the Preferred Provider Network. Similar to Option 1, there is no balance billing. You are responsible for deductibles and coinsurance, and also have the convenience of your provider being reimbursed directly. Option 3—You can receive out-of-network coverage from a dentist who has no relationship with CareFirst. With this option, you may experience higher out-of-pocket costs since you pay your provider directly. You can be balance billed and must pay your deductible and coinsurance as well. Frequently asked questionsHow do I nd a preferred dentist?You can access an online directory 24hours a day a carerst.com/aacps. Click on the Dental tab, followed by Preferred Dental (PPO).How much will I have to pay for dental services?The chart on the following page gives you an overview of many of the covered services along with the percentage of what you will pay for each class of services, both in and out-of-network. Is there a lot of paperwork?There is no paperwork when you see a participating dentist, you are free from ling claims. However, if you use a non-participating dentist, you may be required to pay all costs at the time of care, and then submit a claim form in order to be reimbursed for covered services.Who can I call with questions about my dentalplan?Call Dental Customer Service toll free at: 866-891-2802 between 8:30 am and 5:00 pm ET, Monday–Friday.1 The CareFirst BlueChoice Dental Plan is oered in conjunction with Group Hospitalization and Medical Services, Inc., doing business as CareFirst BlueCross BlueShield, which contracts with participating dentists and provides claims processing and administrative services under the Dental Plan.
■ Anne Arundel County Public Schools—Health Benet Options28 Traditional DentalIncludes access to a National Provider NetworkCareFirst BlueCross BlueShield (CareFirst) and CareFirst BlueChoice, Inc. (CareFirst BlueChoice)1 oer Traditional Dental coverage, which allows you the freedom to see any dentist you choose.Advantages of the plan Freedom of choice, freedom to save—With Traditional Dental coverage, you can see any dentist you choose. However, this plan also gives you the option to reduce your out-of-pocket expenses by visiting a dentist who participates in our Traditional Provider network. It’s your choice! Comprehensive coverage—Benets include regular preventive care, X-rays, dental surgery and more. A summary of your benets is available on the following page. (Additional coverage for orthodontia is included for children and adults.) Nationwide access to participating dentists—You have access to one of the nation’s largest dental networks, with more than 95,000 participating dentists throughout the United States. Traditional Dental gives you coverage for the dental services you need, whenever and wherever you need them. Opportunity to reduce costs—If you see a participating dentist, you will incur lower out-of-pocket costs for all dental services and you will have no claim forms to le. Participating dentists have agreed to accept CareFirst’s allowed benet as payment in full for covered services. Once you meet your deductible and coinsurance, you won’t have any additional expenses. You will not be balance billed! Out-of-network benet—You can receive care from a non-participating dentist and have the same level of coverage; however, you may be subject to higher out-of- pocket costs and balance billing.Frequently asked questionsHow do I nd a traditional dentist?You can access an online directory 24hours a day a carerst.com/aacps. Click on the Dental tab, followed by Traditional Dental (PPO).How much will I have to pay for dental services?The chart on the following page gives you an overview of many of the covered services along with the percentage of what you will pay for each class of services, both in and out-of-network. Is there a lot of paperwork?There is no paperwork when you see a participating dentist, you are free from ling claims. However, if you use a non-participating dentist, you may be required to pay all costs at the time of care, and then submit a claim form in order to be reimbursed for covered services.Who can I call with questions about my dentalplan?Call Dental Customer Service toll free at: 866-891-2802 between 8:30 am and 5:00 pm ET, Monday–Friday.
Anne Arundel County Public Schools—Health Benet Options ■29Dental OptionsActive EmployeesCareFirst TraditionalCareFirst PPOConcordia Plus DHMO MD/DC2060*Benets In-Network Out-of-Network In-NetworkPlan Pays Plan Pays Plan Pays Plan PaysOral Examination 100% of AB 100% of AB 80% of AB $5 copayRoutine Cleaning 100% of AB 100% of AB 80% of AB 100%Sealants(limited to permanent molars– until end of year in which a member turns 19)100% of AB 100% of AB 80% of AB 100%Bitewing X-ray 100% of AB 100% of AB 80% of AB 100%Palliative Treatment 100% of AB 100% of AB 80% of AB 95%Other X-rays as required 100% of AB 100% of AB 80% of AB 100%Space Maintainers 100% of AB 100% of AB 80% of AB 95%Fillings 100% of AB 80% of AB 60% of AB** 100%Simple Extractions 100% of AB 80% of AB 60% of AB** 75%-85%Pulpotomy 100% of AB 80% of AB 60% of AB** 75%-80%Direct Pulp Caps 100% of AB 80% of AB 60% of AB** 75%-80%Root Canals 100% of AB 80% of AB 60% of AB** 75%-80%Apicoectomy 80% of AB** 80% of AB 60% of AB** 75%-80%Oral Surgical Services 80% of AB** 80% of AB 60% of AB** 75%-85%Surgical Extractions 80% of AB** 80% of AB 60% of AB** 75%-85%Oral Surgery 80% of AB** 80% of AB 60% of AB** 75%-85%General Anesthesia 80% of AB** 80% of AB 60% of AB** See note 1Periodontics 50% of AB** 80% of AB 60% of AB** 50%-65%Crown 80% of AB** 80% of AB 60% of AB** 60%-80%Prosthetic Appliances(including implants)50% of AB 80% of AB 60% of AB** 60%-80%Implants not coveredOrthodonticsChildren and Adults50% of AB 50% of AB 35% of AB See note 3Annual Deductible $25 Ind./$50 Family None $50 Ind./$150 Family NoneAnnual Benet Maximum $1,500 $1,500 None/See note 2Ortho Lifetime Maximum $1,500 $1,500 See note 3(AB Allowed Benet)Under the Concordia Plus DHMO (MD/DC 2060*) Plan, out-of-network services are reimbursed up to a maximum amount, based on the fee schedule provided by United Concordia.* The above DHMO Plan percentages are approximate and used for comparison purposes only. Please refer to the United Concordia (UCCI) Schedule of Benets for actual copayment amounts. All coverage is subject to the Plan’s exclusions and limitations.** After DeductibleNote 1—General Anesthesia is considered integral to other procedures under this plan and is not covered separately.Note 2—No annual maximum for in-network services. United Concordia will reimburse up to a maximum of $1,000 per family member per contract year for out-of-network services.Note 3—After $2,900 member copayment satised, benets applicable to in-network services; provider should submit pre-treatment estimate. United Concordia will not reimburse covered members for any orthodontic services performed out-of-network.
■ Anne Arundel County Public Schools—Health Benet Options30 Vision ProgramMaking vision care more aordableVision is one of our most valued assets. Everyone should take precautions to protect this priceless gift. Some vision problems, such as glaucoma, can only be detected through regular, professional vision exams. Without proper care, these problems can gradually grow worse.An important assetThe CareFirst BlueCross BlueShield Vision plan can make a dierence. It makes vision care more aordable, and it encourages people to follow a routine of preventive care for their eyes.An aordable optionVision care is one of the least expensive health care benets you can purchase. It is also one of the rst optional benets chosen by employees when it is oered.Your Vision plan helps you commit to routine eye exams and preventive care that help detect small problems before they becomes serious and costly. Your Vision plan provides benets for: Comprehensive vision examinations Lenses and frames or contact lensesA name you can trustCareFirst BlueCross BlueShield is one of the largest health insurers in Maryland. You will be pleased that you have chosen CareFirst BlueCross BlueShield to provide such an important and valuable benet program.Freedom of choiceYou can choose any licensed vision care provider— within the Davis Vision network along with the Select Vision network. You have complete freedom to choose your own ophthalmologists, optometrists, and opticians. You may choose to see your current provider, a provider convenient to work or home, or take the recommendations of others.Easy to useOur Vision plan is as easy to use as it is eective. You simply show your CareFirst BlueCross BlueShield membership card to participating providers at the time of service. The participating provider will bill us and we pay them directly for their services. You don’t have any paperwork or claims to le.If you choose a non-participating provider for your care, you must pay the provider. We will reimburse you up to the limits of your vision plan.Visit carerst.com/aacps to nd participating Davis Vision and Select Vision providers. To nd a Davis Vision provider, click on the drop down box and choose BlueVision, BlueVision Plus, Pediactric Vision (Davis Vision). To nd a Select Vision provider, choose Select Vision. What is not covered under Select Vision Sunglasses (lenses darker than tint 2), even if prescribed. Replacement, within the same benet period, of lost or damaged frames or lenses (including contacts) for which benets were provided. Exams or materials furnished after the member’s coverage is terminated (unless lenses and frames or contact lenses are ordered prior to the termination date and received within 30 days after the date of the order). Separate exam for contact lens tting.Need more information? Please visit carerst.com/aacps or call 800-783-5602.
Anne Arundel County Public Schools—Health Benet Options ■31Vision Program* The Davis Vision Network has 94,000+ providers nationwide including Retailers (Walmart, Sam’s Club, Costco, Vision Works, Target, JC Penney, My Eye Dr., Pearle Vision and America’s Best), 1-800-CONTACTS and glasses.com.** Following cataract surgery or when visual acuity is correctable to at least 20/70 in the better eye only by use of contact lenses. *** Polycarbonate lenses are covered for dependent children, monocular patients and patients with prescriptions +/- 6.00 diopters or greater. 1 These services or supplies are not considered covered benets under the Plan. This portion of the Plan is not an insurance product. As of 4/1/14, some providers in Maryland and Virginia may no longer provide these discounts.BlueVision Plus Exclusions The following services are excluded from coverage: 1. Diagnostic services, except as listed in What’s Covered under the Evidence of Coverage.2. Medical care or surgery. Covered services related to medical conditions of the eye may be covered under the Evidence of Coverage.3. Prescription drugs obtained and self-administered by the Member for outpatient use unless the prescription drug is specically covered under the Evidence of Coverage or a rider or endorsement purchased by your Group and attached to the Evidence of Coverage.4. Services or supplies not specically approved by the Vision Care Designee where required in What’s Covered under the Evidence of Coverage.5. Orthoptics, vision training and low vision aids.6. Replacement, within the same benet period of frames, lenses or contact lenses that were lost.7. Non-prescription glasses, sunglasses or contact lenses.8. Vision Care services for cosmetic use.Please note: Not all services are covered by your benets contract. This plan summary is for comparison purposes only and does not create rights not given through the benet plan. All benets are subject to the provisions stipulated in the CareFirst BlueCross BlueShield Vision contract. CareFirst BlueCross BlueShield does not warrant the quality of vision services or materials. Summary of Benets: Select Vision/BlueVision PlusSelect Vision (includes in- & out-of-network benets) Plan PaysBlueVision Plus You PayNetwork Select Vision Davis Vision*Routine Eye Exam 100% of Allowed Benet No Copay Frames $45.00 Plan pays up to $45 or up to $95 at Visionworks (plus 20% discount on balance with all Davis Vision Providers)Single Vision Lenses $52.00 No Copay Bifocal Lenses $82.00 No Copay for lined bifocalsTrifocal Lenses $101.00 No Copay for lined trifocalsContact Lenses (Instead of Glasses—Cosmetic) $97.00 Plan pays up to $97Contact Lenses (Medically Indicated**) $352.00 Plan pays up to $352ADDITIONAL LENS OPTIONS1Tinting of Plastic Lenses (Solid/Gradient) N/A $15Scratch-Resistant Coating Polycarbonate Lenses (Children***/Adults)N/A Covered $0/$35Ultraviolet Coating N/A $15Blue Light Filtering N/A $15Anti-Reective Coating (Standard/Premium/Ultra/ Ultimate)N/A $40/$55/$69/$85Progressive Lenses (Standard/Premium/Ultra/ Ultimate)N/A $65/$105/$140/$175High-Index Lenses (1.67/1.74) N/A $60/$120Polarized Lenses N/A $75Plastic Photochromic Lenses N/A $70Scratch Protection Plan (Single Vision, Multifocal Lenses)N/A $20 l $40Blended Segment Lenses N/A $20Photochromic Lenses N/A $20Oversized Lenses N/A Covered
■ Anne Arundel County Public Schools—Health Benet Options32 BlueVision (Davis Vision)A plan for healthy eyes, healthy livesProfessional vision services including routine eye examinations, eyeglasses and contact lenses oered by CareFirst BlueChoice, through the Davis Vision, Inc. national network of providers.How the plan worksHow do I nd a provider?To nd a provider, go to carerst.com/aacps and utilize the Find a Provider feature or call Davis Vision at 800-783-5602 for a list of network providers closest to you. Be sure to ask your provider if he or she participates with the Davis Vision network before you receive care.How do I receive care from a network provider?Simply call your provider and schedule an appointment. Identify yourself as a CareFirst BlueChoice member and provide the doctor with your identication number, as well as your date of birth. Then go to the provider to receive your service. There are no claim forms to le.Can I get contacts and eyeglasses in the same benet period?With BlueVision, you receive one pair of eyeglasses or a supply of contact lenses per benet period at a discounted price.1Mail order replacement contact lensesDavisVisionContacts.com oers members the exibility to shop for replacement contact lenses online after benets are spent. This website oers a wide array of contact lenses, easy, convenient purchasing online and quick shipping direct to your door.Need more information? Please visit carerst.com/aacps or call 800-783-5602.
Anne Arundel County Public Schools—Health Benet Options ■33BlueVision (Davis Vision)Summary of Benets (12-month benet period)In-Network You PayEYE EXAMINATIONS1Routine Eye Examination with dilation (per benet period)$10FRAMES1,2Priced up to $70 retail $40Priced above $70 retail $40, plus 90% of the amount over $70SPECTACLE LENSES2Single Vision $35Bifocal $55Trifocal $65Lenticular $110LENS OPTIONS2,3 (add to spectacle lens prices above)Standard Progressive Lenses $75Premium Progressive Lenses (Varilux®, etc.)$125Ultra Progressive Lenses (digital) $140Polarized Lenses $75High Index Lenses $55Glass Lenses $18Polycarbonate Lenses $30Blended Invisible Bifocals $20Intermediate Vision Lenses $30Photochromic Lenses $35Scratch-Resistant Coating $20Standard Anti-Reective Coating $45Ultraviolet (UV) Coating $15Solid Tint $10Gradient Tint $12Plastic Photosensitive Lenses $65CONTACT LENSES1,2Contact Lens Evaluation and Fitting85% of retail priceConventional 80% of retail priceDisposable/Planned Replacement 90% of retail priceDavisVisionContacts.com Mail Order Contact Lens Replacement OnlineDiscounted pricesLASER VISION CORRECTION2Up to 25% o allowed amount or 5% o any advertised special41 At certain retail locations, members receive comparable value through their everyday low price on examination, frame and contact lens purchase.2 CareFirst BlueChoice does not underwrite lenses, frames and contact lenses in this program. This portion of the Plan is not an insurance product. As of 4/1/14, some providers in Maryland and Virginia may no longer provide these discounts.3 Special lens designs, materials, powers and frames may require additional cost.4 Some providers have at fees that are equivalent to these discounts.ExclusionsThe following services are excluded from coverage:1. Diagnostic services, except as listed in What’s Covered under the Evidence of Coverage.2. Medical care or surgery. Covered services related to medical conditions of the eye may be covered under the Evidence of Coverage.3. Prescription drugs obtained and self-administered by the Member for outpatient use unless the prescription drug is specically covered under the Evidence of Coverage or a rider or endorsement purchased by your Group and attached to the Evidence of Coverage.4. Services or supplies not specically approved by the Vision Care Designee where required in What’s Covered under the Evidence of Coverage.5. Orthoptics, vision training and low vision aids.6. Glasses, sunglasses or contact lenses.7. Vision Care services for cosmetic use.8. Services obtained from Non-Contracting Providers.For BlueChoice Opt-Out Plus members, Vision Care benets are not available under the Out-of-Network Evidence of Coverage.Exclusions apply to the Routine Eye Examination portion of your vision coverage. Discounts on materials such as glasses and contacts may still apply.Benets issued under policy form numbers: MD/BC-OOP/VISION (R. 6/04) • DC/BC-OOP/VISION (R. 6/04) • VA/BC-OOP/VISION (R. 6/04)
■ Anne Arundel County Public Schools—Health Benet Options34 My AccountOnline access to your health care informationMy Account makes it easier than ever to understand and manage personalized information about your health plan and benets. Set up an account today! Go to carerst.com/aacps to create a username and password.As viewed on a computer.Home Quickly view plan information including eective date, copays, deductible, out-of-pocket status and recent claimsactivity Manage your personal prole details including password, username and email, or choose to receive materials electronically Send a secure message via the Message Center Check Alerts for important noticationsAs viewed on a smartphone.My Account at a glanceCoverage Access your plan information—plus, see who iscovered Update your other health insurance information, ifapplicable View, order or print member ID cards Review the status of your health expense account (HSA or FSA)1 Order and rell prescriptions View prescription drug claims1221 3 4 5 6 7 821345678Signing up is easyInformation included on your member ID card will be needed to set up your account. Visit carerst.com/aacps Select Register Now Create your username and password1 Only if oered by your plan.
Anne Arundel County Public Schools—Health Benet Options ■35My AccountClaims Check your claims activity, status and history Review your Explanation of Benets (EOBs) Track your remaining deductible and out-of-pockettotal Submit out-of-network claims Review your year-end claims summaryDocuments Look up plan forms and documentation2 Download Vitality, your annual member resourceguideAs viewed on a computer.As viewed on a smartphone.Doctors Find in-network providers and facilities nationwide, including specialists, urgent care centers and labs Select or change your primary care provider (PCP) Locate nearby pharmaciesMy Health Access health and wellness discounts throughBlue365 Learn about your wellness program options1 Tools Access the Treatment Cost Estimator to calculate costs for services andprocedures3 Use the drug pricing tool to determine prescriptioncostsHelp Find answers to many frequently askedquestions Send a secure message or locate important phonenumbers35468721 3 4 5 6 7 8213456781 Only if oered by your plan. 2 Only available when using a computer.3 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 medicaladvice.BRC6499-1P (2/18)_C
■ Anne Arundel County Public Schools—Health Benet Options36 Mental Health SupportWell-being for mind and bodyLiving your best life involves good physical and mental health. Emotional well-being is important at every stage in life, from adolescence through adulthood.It’s common to face some form of mental health challenge during your life. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) are here to help. Our support team is made up of specially trained service representatives, registered nurses and licensed behavioral health clinicians, ready to: Help you nd the right mental health provider(s) and schedule appointments Connect you with a care coordinator who will work with your doctor to create a tailored action plan Find support groups and resources to help you stay on trackWhen mental health diculties arise for you or a loved one, remember you are not alone. Help is available and feeling better is possible. CareFirst members have access to specialized services and programs for depression, anxiety, drug or alcohol dependence, eating disorders, and other mental health conditions.If you are in crisis, helpis available 24/7 at800-245-7013.If you or someone close to you needs support or help making an appointment, call our support team at 800-245-7013, Monday-Friday 8 a.m.–6 p.m. ET. Or for moreinformation, visit carerst.com/mentalhealth. SUM3223-1P (5/19)
Anne Arundel County Public Schools—Health Benet Options ■37Health & WellnessPutting the power of health in your handsImproving your health just got easier! Brought to you in partnership with Sharecare, Inc.,* the highly personalized CareFirst BlueCross BlueShield (CareFirst) wellness program can help you live a healthier life. Catering to your unique health and wellness goals, our program oers motivating digital resources accessible anytime, plus specialized programs for extra support.Ready to take charge of your health?Find out if your healthy habits are truly making an impact by taking the RealAge® health assessment! In just a few minutes, RealAge will help you determine the physical age of your body compared to 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 resources and tools that reect your own preferences and interests. You get: Trackers: Connect your wearable devices or enter your own data to monitor daily habits like sleep, steps, nutrition and more. A personalized health timeline: Receive content and programs tailored to you. Challenges: Stay motivated by joining a challenge to make achieving your health goals more entertaining. Inspirations and Relax 360°: Break free from stress, unwind at the end of the day or ease into a restful night of sleep with meditation, streaming music and videos.Download the mobile app to access wellness tools and resources whenever and wherever you want.*Sharecare, Inc. is an independent company that provides health improvement management services to CareFirst members.
■ Anne Arundel County Public Schools—Health Benet Options38 Health & WellnessSpecialized programsThe following programs can help you focus on specic wellness goals. For more information about any of these programs, please call Sharecare support at 877-260-3253.Health coaching Coaches are registered nurses and trained professionals who provide one-on-one support to help you reach your wellness goals. If you are interested in health coaching or are contacted, we encourage you to take advantage of this voluntary and condential program that can help you achieve your best possible health. Weight management programImprove your overall health, reach a healthier weight and reduce your risk for pre-diabetes and associated chronic diseases. Tobacco cessation programQuitting smoking and other forms of tobacco can lower your risk for many serious conditions from heart disease and stroke to lung cancer. Our program’s expert guidance, support and online tools make quitting easier than you might think. Financial well-being programLearn how to take small steps toward big improvements in your nancial situation. Whether you want to stop living paycheck to paycheck, get out of debt, or send a child to college, our nancial well-being program can help. Additional oerings Wellness discount program— Sign up for Blue365 at carerst.com/wellnessdiscounts to receive special oers from top national and local retailers on tness gear, gym memberships, healthy eating options and more. Vitality magazine—Read our member magazine which includes important plan information at carerst.com/vitality. Health education—View our health library for more health and well-being information at carerst.com/livinghealthy.Log in today. If you don’t already have a Sharecare account, visit carerst.com/sharecare. You’ll need to enter your CareFirst My Account username and password and complete the one-time registration with Sharecare to link your CareFirst account information. Thiswill help personalize your experience.This wellness program is administered by Sharecare, Inc., an independent company that provides health improvement management services to CareFirst members. Sharecare, Inc. does not provide CareFirst BlueCross BlueShield products or services and is solely responsible for the health improvement management services it provides. SUM5019-1P (1/20)Wellness
Anne Arundel County Public Schools—Health Benet Options ■39Preventive Service Guidelines for AdultsTo stay healthy, adults need preventive check-ups. These guidelines* describe recommended preventive services that most adults need. Depending on your personal health care needs or risk factors, your doctor may give you a dierent schedule. If you think you may be at risk for a particular condition, talk to your doctor.To verify your benets, check your benets contract, your enrollment materials or log in to MyAccount at carerst.com/myaccount.Counseling and education Depending on the patient’s age, health care providers will discuss one or more of these topics or provide screenings during exams: Drug and alcohol use Tobacco use Harmful eects of smoking on children’s health Physical activity and diet, including recommended changes Injury prevention Dental health Hepatitis A, B and C Sexual behavior Sexually transmitted diseases Use of alternative medicines and therapies Tuberculosis (TB) Domesticviolence Aspirin therapy Sleep patterns Sun safety/skin cancer preventionScreenings for men and women ages 21 & older Medical history and physical exam: At the advice of thedoctor Height: At least once with follow-up as needed Weight: Screen all adults for obesity; body mass index (BMI)recommended at least every two years Blood pressure: At least every 2 years if blood pressure is less than 120/80Every year if systolic measure (top number) is 120–139 or diastolic measure (bottom number) is 80–90 Cholesterol: Every 5 years for men and women ages 20 andolder Diabetes: Every 3 years for patients with any of these riskfactors: Overweight (BMI greater than or equal to 25)Family history of diabetesHigh blood pressureHigh cholesterolHigh blood sugarHistory of vascular diseaseInactivityAfrican American, Latino, Native American, Asian American or Pacic Islanderrace/ethnicity COPD: Spirometry for patients with dyspnea, chronic cough/sputum production and history of risk factors Colorectal cancer: Ages 45-75 with average risk. The decision to screen before or after thisage range should be between you and your doctor. Discuss the possible benets and harm of screening and treatment with your doctor. The options for colorectal cancer screeningare:Fecal immunochemical test annually High-sensitivity, guaiac-based fecal occult blood test annuallyMultitarget stool DNA test every 3 yearsColonoscopy every 10 years Computed tomography colonography every 5 years Flexible sigmoidoscopy every 5 years* Guidelines are adapted from a variety of sources including: United States Preventive Services Task Force; American Diabetes Association; American Cancer Society, and National Comprehensive Cancer Network.
■ Anne Arundel County Public Schools—Health Benet Options40 Preventive Service Guidelines for Adults Depression: Screen men and women every year Hepatitis B: For men and women at increased risk forinfection Hepatitis C: At least once for those born between 1945 and1965 Human immunodeciency virus (HIV): For men and women at increased risk for HIV infection Syphilis: For men and women at increased risk for syphilisinfectionScreenings for women only Breast cancer: Routine screening every 2 years for women aged 50 to 74 years. The decision to start screening before the age of 50 should be between you and your doctor. Discuss the possible benets and harm of screening and treatment with your doctor. Hereditary breast and ovarian cancer screening: Women who carry the genes associated with increased risk (a strong family history of breast, ovarian, tubal or peritoneal cancer) should be referred for genetic counseling and evaluation for testing Cervical cancer:Pap smear every 3 years for ages 21–29For women ages 30 and older, Pap smear alone every 3 years OR a combination of Pap smear and HPV testing every 5yearsScreening is not recommended for women older than 65 who have had adequate prior screeningScreening is not suggested for women who have had a hysterectomy with removal of the cervix Chlamydia: For sexually active women ages 25 and younger who are not pregnant; the doctor may advise the test for women older than age 25 Cystic Fibrosis carrier screening: For women of child-bearing age, preferably before conception Osteoporosis:Begin at age 65 or older for women at average risk. Women at greater risk should be screened at an earlier age.Counseling for women ages 21 and older to get enoughcalcium Menopause counseling: Women who are of menopausal age should be counseled about menopause, risks and benets of estrogen replacement, treatment and lifestyle changes Screening pelvic exam: Is not recommended for women with no symptoms and who are not pregnant. The decision not to have this exam should be between you and your doctor. Discuss the benets and harm with your doctor.Screenings for men only Prostate cancer: Discuss the possible benets and harm of screening and treatment with your doctor Aortic abdominal aneurysm: One-time ultrasonography for men ages 65 to 75 who smoke or have smoked Osteoporosis: Periodic screenings for older men with risk factorsFind more information about adult immunizations, visit carerst.com/prevention and click on the Adults link under Shots.CareFirst Preventive Service Guidelines are for physician practice and patient care and do not dene member benets. These guidelines are general recommendations for members with no special risk factors. Variations are appropriate based on individual circumstances. Approved by CareFirst’s Quality Improvement Council—April 2018.
Anne Arundel County Public Schools—Health Benet Options ■41Preventive Service Guidelines for ChildrenTo stay healthy, children need routine shots and preventive check-ups. These guidelines* describe recommended preventive services that most children need. Depending on your child’s personal health care needs or risk factors, your doctor may give you a dierent schedule. If you think your child may be at risk for a particular condition, talk to your doctor.To verify your benets, check your benets contract, your enrollment materials or log in to MyAccount at carerst.com/myaccount.Counseling and screenings Your health care provider should discuss these topics at every exam, depending on your child’sage: Injury prevention Diet and exercise Substance use Smoking Dental health: Check-ups twice a year, beginning at 12 months Sexual behavior Depression Domestic violence Use of alternative medicine and therapies Sun safety/skin cancer prevention Fluoride supplementationBirth to 24 months Medical history and exam: At birth to 1 month and at 2, 4, 6, 9, 12, 15, 18 and 24 months Height, weight, hearing, vision, head measurement, body mass index (BMI) percentile, and assessment of growth, development and behavior: Each visit Congenital heart disease: After 24 hours of age before discharge from the hospital Congenital hypothyroidism: 2–4 days of age Tests required by state law: By 1 month Tuberculosis: Assess risk at 1, 6, 12 and 24 months. Testing should be performed on recognition of high risk factors Bilirubin screening: First newborn visit Lead poisoning: Assess risk at 6, 9, 12, 18 and 24 months. Perform blood test at 12 and 24 months in high prevalence areas Anemia: Assess risk at 4, 12, 15, 18 and 24 months. Perform blood test at 12 months Autism screening: At18 month visit and 24 month visit Sexually transmitted disease: HIV test for infants born to mothers whose HIV status isunknown Sickle Cell Disease: Once between 9–12 months Nutrition counseling: From birth to 21 months, check the baby’s eating habitsRemember to use rm bedding and place healthy babies on their backs to sleep.Find out when your child’s shots are due at: carerst.com/prevention. For more information about health and wellness, visit carerst.com/livinghealthy.* Guidelines are adapted from a variety of sources including: American Academy of Pediatrics; American Academy of Family Physicians; Centers for Disease Control and Prevention, and United States Preventive Services Task Force.
■ Anne Arundel County Public Schools—Health Benet Options42 Preventive Service Guidelines for ChildrenAges 2 to 10 Medical history and exam: Ages 2, 2½, 3, 4, 5, 6, 7, 8, 9 and 10 Height, weight, hearing, vision, and assessment of growth, development and behavior: Each visit; BMI percentile once a year, starting at age2 Head measurement: Until age2 Blood pressure: Each visit, beginning at age 3 Urinalysis: Age 5 Cholesterol: Test one time between 9–11 years Rubella: Vaccination history or blood test for girls of child-bearing age, beginning at age10 Tuberculosis: Assess risk annually from 2–10 years. Testing should be performed on recognition of high-risk factors Anemia: Assess risk at 24 months, 30 months, 3 years and annually thereafter Lead poisoning: Assess risk annually between 2–6 years Body Mass Index (BMI): Screen at 24 months, 30 months, 3 years and annually thereafter Diabetes: Testing every 3 years, beginning at age 10 or at onset of puberty, whichever comes rst, if these conditionsapply:Overweight (body mass index > 85th percentile or weight > 120% of ideal forheight)Family history of type 2 diabetesNative American, African American, Latino, Asian American or PacicIslander race/ethnicityAges 11 to 21 Medical history and exam: Once a year Height, weight, hearing, vision, and assessment of growth, development and behavior: Each well visit; BMI percentile once a year Blood pressure: Each visit Cholesterol: Test one time between 17–21 years Rubella: Vaccination history or blood test for females of childbearing age Anemia: Assess risk annually. Screen females once a year after periods begin Urinalysis: Beginning at age 11, screen annually if sexually active Tuberculosis: Assess risk annually from 11–21 years. Testing should be performed on recognition of high-risk factors Depression: Screen annually between 12–21 years of age Sexually transmitted diseases: Screen if sexually active or at high risk beginning at age 11 Screen for HIV once between 15–18 and test annually if at high risk Pelvic exam: Most women under age 21 should not be screened for cervical cancer regardless of sexual activity or other factors Calcium counseling: Beginning at age11 Body Mass Index (BMI): Screen annually between 11–21 yearsDepending on your child’s age and history, your doctor may screen for other high-risk conditions, including hepatitis A, B and C, chlamydia, gonorrhea andHIV.CareFirst Preventive Service Guidelines are for physician practice and patient care and do not dene member benets. These guidelines are general recommendations for members with no special risk factors. Variations are appropriate based on individual circumstances. Approved by CareFirst’s Quality Improvement Council—April 2018.
Anne Arundel County Public Schools—Health Benet Options ■43Notice of Nondiscrimination and Availability of Language Assistance Services(UPDATED 8/5/19)CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst of Maryland,Inc., Group Hospitalization and Medical Services, Inc., CareFirst BlueChoice, Inc., The Dental Network and First Care, Inc. are independent licensees of the Blue Cross and BlueShield Association. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). The Blue Cross® and Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.CareFirst BlueCross BlueShield, CareFirst BlueChoice, Inc., CareFirst Diversied Benets and all of their corporate aliates (CareFirst) comply with applicable federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. CareFirst does not exclude people or treat them dierently because of race, color, national origin, age, disability or sex.CareFirst: Provides free aid and services to people with disabilities to communicate eectively with us, such as:Qualied sign language interpretersWritten information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as:Qualied interpretersInformation written in other languagesIf you need these services, please call 855-258-6518.If you believe CareFirst has failed to provide these services, or discriminated in another way, on the basis of race, color, national origin, age, disability or sex, you can le a grievance with our CareFirst Civil Rights Coordinator by mail, fax or email. If you need help ling a grievance, our CareFirst Civil Rights Coordinator is available to help you. To le a grievance regarding a violation of federal civil rights, please contact the Civil Rights Coordinator as indicated below. Please do not send payments, claims issues, or other documentation to this oce.Civil Rights Coordinator, Corporate Oce of Civil RightsMailing Address P.O. Box 8894 Baltimore, Maryland 21224Email Address civilrightscoordinator@carerst.comTelephone Number 410-528-7820 Fax Number 410-505-2011You can also le a civil rights complaint with the U.S. Department of Health and Human Services, Oce for Civil Rights electronically through the Oce for Civil Rights Complaint portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at:U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 800-368-1019, 800-537-7697 (TDD)Complaint forms are available at http://www.hhs.gov/ocr/oce/le/index.html.
■ Anne Arundel County Public Schools—Health Benet Options44 Notice of Nondiscrimination and Availability of Language Assistance ServicesForeign Language Assistance
Anne Arundel County Public Schools—Health Benet Options ■45Notice of Nondiscrimination and Availability of Language Assistance Services
■ Anne Arundel County Public Schools—Health Benet Options46 Notice of Nondiscrimination and Availability of Language Assistance Services
Health benets administered by:CONNECT WITH US:CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst MedPlus is the business name of First Care, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the business name of CareFirst Advantage, Inc. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., The Dental Network, Inc., First Care, Inc., CareFirst BlueChoice, Inc., and CareFirst Advantage, Inc. are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.CST3394-1N (9/20)