Health Plan Information

We know healthcare can be complicated. To learn more, choose a topic from the list below.

If you’re a member, please refer to your plan benefits and services by logging in to My Account. Or, call Member Services at the number on the back of your member ID card.

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All of our plans include core health benefits, including:

  • Office visits
  • Maternity and newborn care
  • Prescription drugs
  • Laboratory tests and X-rays
  • Preventive and wellness care
  • Dental and vision for children under age 19
  • Emergency services
  • Hospitalization
  • Behavioral health and substance use disorder
  • Physical, speech and occupational therapy

Acupuncture, bariatric surgery, cosmetic surgery, dental care (adult), hearing aids, infertility treatment, long-term care, private-duty nursing, routine foot care, and weight loss programs.

To use the Find a Doctor tool, log in or select the Guest option. Enter your zip code and then select a network. Choose All Plans, then Medical from the drop down list. You will then see an option to search Primary Care Providers. This tool will show you primary care physicians who are in-network for CareFirst's Blue Cross Blue Shield coverage, with their specialty, whether they are accepting new patients, what languages they speak, where they went to medical school, and their practice address and phone number. Learn more about selecting a doctor.

Members may seek specialty care and behavioral healthcare from in-network or out-of-network providers. Be sure to talk with your primary care provider about your preferences. Depending on your plan, you may need a referral from your primary care provider in order to access specialty care. Refer to your member benefit booklet for details.

Members can log in to My Account to find participating in-network providers and facilities with the Find a Doctor tool. Certain nonemergency hospital and other medical services require preapproval from CareFirst. Customer Service can assist you with the directory or help you locate a practitioner or facility within a specific geographic area.

If your primary care provider (PCP) isn’t available for an appointment, CareFirst Video Visit can securely connect you with a doctor anytime, anywhere via smartphone, tablet or computer. Video Visit doctors are U.S. board-certified licensed and credentialed to provide consultations, diagnose illnesses and write prescriptions.

Members also have 24/7 access to our free nurse advice line for help when you can’t reach your PCP or are unsure about your symptoms.

Members are encouraged to download CareFirst’s free mobile app to locate providers, urgent care centers, emergency rooms and more, 24/7.

HMO and POS plans: When you see an out-of-area participating BlueCross BlueShield doctor or hospital for emergency or urgent care, you only pay out-of-pocket expenses, like a copayment. Your provider files the claim, which is paid at the in-network level. If your plan provides out-of-network benefits, those covered services are paid at the out-of-network benefit level.

PPO, PPN, and MPOS plans: When you arrive at the doctor’s office or hospital, you will present your current CareFirst member ID card with the suitcase logo. After you receive medical attention, your provider will file the claim.

CareFirst pays all participating and preferred doctors and hospitals directly. You are only responsible for any out-of-pocket expenses (non-covered services, deductibles, copayments or coinsurance). If the provider does not participate with a BCBS plan, you must pay at the time of service.

When you receive services from a provider or pharmacy that participates in the CareFirst BlueCross BlueShield or CareFirst BlueChoice network, the provider’s office or the pharmacy will submit claims for you. However, if you visit a non-participating provider or non-participating pharmacy for service, you must submit the claim yourself. You can submit your claim one of two ways:

  • Mail your claim form
    To print and mail your claim form, log in to My Account, select the My Documents tab, choose Forms. Choose the form for your type of claim and fill in the required information. Then, mail the form using the directions included. If you do not have internet access, you may request a paper claim form by calling Member Services at the telephone number on the back of your member ID card.
  • Submit your claim form online
    CareFirst also offers online claims submission for medical, dental and behavioral health claims. From your computer or mobile device, log in to My Account and select Claims. Choose Submit a Claim Online, then Start New Claim. Enter the requested information, upload the required documents and submit.

To ensure our members have access to safe and effective care, CareFirst reviews new developments in medical technology and new applications of existing technology for inclusion as a covered benefit. We evaluate new and existing technologies for medical and behavioral health procedures, medications and devices through a formal review process. We also consider input from medical professionals, government agencies and published articles about scientific studies.

If you have concerns regarding a decision that adversely affect coverage, such as a denial, a reduction of benefits, or a denial of authorization for services, you may call the Member Services telephone number on the back of your member ID card. A representative can assist you with resolving the issue or initiating the appeal process. If needed, language interpretation is available.

If you would like to review the procedure for filing an appeal, visit carefirst.com/appeals. For a printed copy, call Member Services at the telephone number on the back of your member ID card. In addition, many members have a right to an independent external review of any final appeal or grievance decision. Refer to your Evidence of Coverage for more specific information regarding initiating an external review, a final appeal determination or a complaint.

If you need language assistance or have questions, call the Member Services telephone number on the back of your member ID card.

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