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					An Overview of
Health Benefits for


            State of Maryland
       Benefit Coordinator Training

               Benefit Period
        July 1, 2009 – June 30, 2010

            CareFirst BlueCross BlueShield is the business name of CareFirst of Maryland, Inc., and is an independent licensee of the Blue Cross and Blue Shield Association.   1
                                               ® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc.
                General Information
CareFirst mailing Healthcare Options Booklets to all current State of
Maryland subscribers

New ID Cards will be issued for all members whether they make changes

Minimal supply of directories at open enrollment fairs. Flyers will be
available on How to Locate a Provider via the State dedicated website

BlueChoice HMO members who make no changes during open enrollment
will automatically be upgraded to the CareFirst EPO product effective July
1, 2009

PPO and POS products continue to be offered to State members



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EPO (Exclusive Provider Organization)

National network

No out-of-network benefits

No selection of Primary Care Physician and no referrals for Specialists
benefits

Mental health services provided through Magellan Health Services

No lifetime maximum




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PPO (Preferred Provider Organization)
National network

No selection of Primary Care Physician and no referrals for Specialists

Out-of-network benefits available subject to deductible

Mental health service are carved out

Lifetime max of $2M




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   MPOS (Maryland Point of Service)

Offered to members who reside in the MD, DC & Northern Virginia

Each member on the policy must select a primary care physician (each member
receives individual ID card specifying PCP (Primary Care Physician)

Referral for Specialist care is required

New members must complete a PCP selection card

Mental health Services are carved out

Out-of-network benefits available subject to deductible

Lifetime Max $2M


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                          Transition of Care
 Available to prospective CareFirst members who
 are receiving services for an acute medical
 condition from another carrier who is not in our
 network




The following medical conditions may qualify for CareFirst Transition of Care Program

     •   Pregnancy (beyond 24 weeks gestation and/or “at risk” pregnancies)
     •   Bone Fracture
     •   Recent Heart Attack
     •   Acute Trauma or Surgery
     •   Joint Replacement
     •   Newly Diagnosed Cancer




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Transition of Care (continued)
     Program allows the eligible member to continue to receive
     care from a non-network physician for up to 90 days following
     the date of enrollment

     Members must complete the Request for Transition of Care
     Form along with required documentation from the physician.
     We request the form as soon as the possible so that
     coordination between carriers can begin

     The request is reviewed and the provider is notified by phone
     of the determination within 2 business days providing all
     required document is received




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