In general, all options under each type of plan (PPO or EPO) cover the same services. However, the participating provider networks for each plan are different. All plans include vision services, mental health services, and supplies.
How the Plans Work
Once enrolled in a medical plan, the employee will receive identification cards in the mail to be used every time medical services are received. Depending on the type of medical plan chosen, the way medical services are received and how much is paid at the time of service will vary. Please review the plans carefully when selecting a suitable plan. PPO plans offer out-of-network benefits. EPO plans do not provide out-of-network benefits except for true emergencies.
- CareFirst Evidence of Coverage EPO
- CareFirst Evidence of Coverage PPO
- CareFirst Coverage for Employee Working Overseas
Coordination of Benefits
Coordination of benefits (COB) occurs when a person has health care coverage under more than one insurance plan. All plans require information from employees and retirees on other coverage that they or their dependents have from another health insurance carrier to determine which plan is primary.
When a Provider Terminates from the Plan Network
Providers may decide to terminate from a plan network at any time. A provider terminating from a plan is not considered a qualifying event that would allow coverage to be canceled or changed. Employees must wait until the next Open Enrollment period to make any changes to plans.
How to Contact
Carefirst BlueCross BlueShield EPO, PPO
1-410-581-3601 (Baltimore)
1-800-225-0131 (outside Balitmore)
TTY: 1-800-735-2258
CareFirst Nurse Line 1-800-535-9700
http://www.carefirst.com/statemd
