BlueChoice HMO (www.carefirst.com)
The HMO plan offers the flexibility to see any of the 35,000 participating providers in the CareFirst BlueChoice network. Only emergency medical services are covered outside of the network. The amount the plan pays for covered services is based on the allowed amount. Your out-of-pocket costs may include office visit copayments, deductibles and coinsurance.
If you have questions or need assistance, contact the PSA Benefits Hotline at 1-877-716-6618 or email Loyola@psafinancial.com.
The Member’s Primary Care Physician "PCP" will coordinate routine care and provide treatment for a variety of medical conditions. If more specialized care is required, the PCP will refer the Member to a Specialist or other Contracted Health Care Provider. Services that do not require a referral include Emergency Services and Urgent Care, obstetric or gynecology, and mental health and substance abuse disorder services.
CareFirst Video Visit is available when your primary care provider isn't. Securely connect with a doctor using your smartphone, tablet or computer. The cost for Video Visit varies based on your benefits, but will never be more than $49. Read the details here.
Traveling outside of the service area? Read about BlueCard Worldwide before your trip. A representative is available to answer your questions 24 hours a day, seven days a week at 1-800-810-2583 or collect call at 1-804-673-1177.
Contraceptive and sterilization services and procedures are not covered under any of the Loyola sponsored medical plans. These services are available directly from CareFirst. Access the benefit by providing your insurance card as you normally do to an in-network pharmacy (services and procedures will not be covered out-of-network). CareFirst will in turn arrange payment directly to the pharmacy. Contact CareFirst Member Services at 1-800-628-8549 for additional information.
Finding a Doctor
To locate an in-network provider, go to the on-line directory at www.carefirst.com, or contact member services by phone at 1-800-628-8549.
Mental Health/Substance Abuse
The Plan provides inpatient, intermediate and outpatient care. Mental health and substance use disorder services must be coordinated through the mental health and substance abuse administrator rather than through the PCP.
Prescription Drug Plan
Participants in the plan automatically participate in the prescription drug plan administered by CVS CareMark. You can choose between retail and mail order options. If you are taking maintenance prescription medication, we encourage you to investigate the CVS Mail Service Pharmacy. Members can sign up for mail order today by calling 1-800-241-3371, through My Account, or by completing the Mail Service Pharmacy Order Form.
HMO Benefit Resources:
FY18 BlueChoice HMO Summary of Benefits and Coverage Chart - This is the format mandated by the Affordable Care Act
Summary of Employee Benefits 2017-2018
FY18 Monthly Medical Plan Premiums
Restricted Generic Prescriptions - save money by using generic prescriptions
Formulary 2 Prescriptions - list of medications moved to Formulary 2
Voluntary Maintenance Choice Prescription Program - save money by using CVS Mail Service
BlueChoice Summary Plan Document
BlueChoice HMO Amendment
HMO Medical Claim Form
Total Cost Estimator
HMO Away From Home Care
Total Care and Cost Improvement Program