Benefits
A look at your benefits.
As a member of CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) you have access to the following benefits and services: medical, prescription drug, pregnancy, diabetes management, and more. Learn more below about how to access them!
*There are no costs to CareFirst CHPMD members for covered medical services.
Please call us if you receive a bill for services.
Medical and Prescription Drug Coverage
Your plan covers all the HealthChoice benefits and services listed below.
| Benefit | What it is | Who can get this benefit | What you do not get with this benefit |
| Primary Care Services | These are all of the basic health services you need to take care of your general health needs, and are usually provided by your primary care provider (PCP). A PCP can be a doctor, advanced practice nurse, or physician assistant. | All members | |
| Early Periodic Screening Diagnosis Treatment (EPSDT) Services for Childrenhttps://mmcp.health.maryland.gov/EPSDT/Pages/Home.aspx | Regular well-child check- ups, immunizations (shots), developmental screens and wellness advice. These services provide whatever is needed to take care of sick children and to keep healthy children well. | Under age 21 | |
| Pregnancy-related Services | Medical care during and after pregnancy, including hospital stays, doula support and, when needed, home visits after delivery. | Women who are pregnant, and for one year after the birth. | |
| Family Planning | Family planning office visits, lab tests, birth control pills and devices (includes latex condoms and emergency contraceptives from the pharmacy, without a doctor’s order) and permanent sterilizations. | All members | |
| Primary Mental Health Services | Primary mental health services are basic mental health services provided by your PCP or another provider within the MCO. If more than just basic mental health services are needed, your PCP will refer you to, or you can call the Public Behavioral Health System at 800-888-1965 for specialty mental health services. | All members | You do not get specialty mental health services from the MCO. For treatment of serious emotional problems your PCP or specialist will refer you or you can call the Public Behavioral Health System at:800-888-1965. |
| Dental Services | The Maryland Healthy Smiles Dental Program covers a wide range of dental services including regular checkups, teeth cleaning, fluoride treatments, x-rays, fillings, root canals, crowns, extractions, and anesthesia. To find a dentist, replace a member ID or handbook, or to learn more about covered services, call Maryland Healthy Smiles Member Services at 1-855-934-9812. | All members | |
| Prescription Drug Coverage (Pharmacy Services) | Prescription drug coverage includes prescription drugs (drug dispensed only with a prescription from an authorized prescriber) insulin, needles and syringes, birth control pills and devices, coated aspirin for arthritis, iron pills (ferrous sulfate), and chewable vitamins for children younger than age 12. You can get latex condoms and emergency contraceptives fromthe pharmacy without a doctor’s order. | All membersThere are no copays for children under age 21, pregnant women, and for birth control. | |
| Specialist Services | Health care services provided by specially trained doctors, advanced practice nurses or physicians assistants. You may need a referral from your PCP before you can see a specialist. | All members | |
| Laboratory & Diagnostic Services | Lab tests and X-rays to help find out the cause of an illness. | All members | |
| Home Health Care | Health care services received in-home that includes nursing and home health aide care. | Those who need skilled nursing care (care provided by or under the supervision of a registered nurse) in their home, usually after being in a hospital. | No personal care services (help with daily living) |
| Case Management | A case manager may be assigned to help you plan for and receive health care services. The case manager also keeps track of what services are needed and what has been provided. You must communicate with your case manager to receive effective case management. | (1) Children with special health care needs;(2) Pregnant and postpartum women;(3) Individuals with HIV/ AIDS;(4) Individuals who are Homeless;(5) Individualswith physical or developmental disabilities;(6) Children in State- supervised care(7) Case management provided by MCO for other members as needed | |
| Diabetes Care | Special services, medical equipment, and supplies for members with diabetes. | Members who have been diagnosed with diabetes. | |
| Diabetes Prevention Program | A program to prevent diabetes in members who are at risk. | Members 18 to 64 years old who are overweight and have elevated blood glucose level or a history of diabetes during pregnancy. | Not eligible if previously diagnosed with diabetes or if pregnant. |
| Podiatry | Foot care when medically needed. | All members | Routine foot care; unless you are under 21 years of age or have diabetes or vascular disease affecting the lower extremities. |
| Vision Care |
Eye Exams:
Glasses and Contact Lenses:
|
Exams: all members.Glasses and contact lenses: Members under age 21. | More than one pair of glasses per year unless lost, stolen, broken or new prescription needed. |
| Oxygen and Respiratory Equipment | Treatment to help breathing problems | All members | |
| Hospital Inpatient Care | Services and care received for scheduled and unscheduled admittance of inpatient hospital stays (hospitalization). | All members with authorization or as an emergency | |
| Hospital Outpatient Care | Services and care received from an outpatient hospital setting that does not require inpatient admittance to the hospital. Services would include diagnostic and laboratory services, physician visit, and authorized outpatient procedures. | All members | MCOs are not required to cover hospital observation services beyond 24 hours. |
| Emergency Care | Services and care received from a hospital emergency facility to treat and stabilize an emergent medical condition. | All members | |
| Urgent Care | Services and care received from an urgent care facility to treat and stabilize an urgent medical need. | All members | |
| Hospice Services | Home or inpatient services designed to meet the physical, psychological, spiritual, and social needs for people who are terminally ill. | All members | |
| Nursing Facility/Chronic Hospital | Skilled nursing care or rehab care up to 90 days. | All members | |
| Rehabilitation Services/ Devices | Outpatient services/ devices that help a member function for daily living. Services include: Physical, Occupational, and Speech Therapy | Members age 21 and olderMembers under 21 are eligible under EPSDT (see section 6 E) | |
| Habilitation Services/ Devices | Services/devices that help a member function for daily living. Services include: Physical Therapy, Occupational Therapy, and Speech Therapy. | Eligible members; benefits may be limited | |
| Audiology | Assessment and treatment of hearing loss | All members | Members over 21 must meet criteria. |
| Blood and Blood Products | Blood used during an operation, etc. | All members | |
| Dialysis | Treatment for kidney disease. | All members | |
| Durable Medical Equipment (DME) & Disposable Medical Supplies (DMS) | DME (can use repeatedly) are things like crutches, walkers, and wheelchairs) DMS (cannot use repeatedly) are equipment and supplies that have no practical use in the absence of illness, injury, disability or health condition. DMS are things like finger stick supplies, dressings for wounds, and incontinence supplies | All members | |
| Transplants | Medically necessary transplants. | All members | No experimental transplants. |
| Clinical Trials | Members costs for studies to test the effectiveness of new treatments or drugs | Members with little threatening conditions, when authorized. | |
| Plastic and Restorative Surgery | Surgery to correct a deformity from disease, trauma, congenital or development abnormalities or to restore body functions. | All members. | Cosmetic surgery to make you look better. |
Additional Benefits (Vision, OTC, 24/7 Nurse Advice Line, and more)
As a member of CareFirst CHPMD, you have access to all the following additional benefits:
Adult Vision – $150 limit for glasses or contact lens! Contact Superior Vision at 1-800-879-6901 to learn more.
Acupuncture – 2 treatments per week (up to 70 treatments a year) are covered through contracted providers in Baltimore City if you have been diagnosed with a substance abuse addiction. Call Member Services to learn more Monday-Friday, 8:00 a.m.–5:00 p.m. Local: 1-410-779-9369 | Toll-free: 1-800-730-8530 | TTY: 711
24/7 Nurse Advice Line – Need help to decide if you should go to you PCP, Urgent Care, or the Emergency Room or what to talk to you provider about? Call the 24/7 Nurse Advice Line at 833-968-1773 anytime to speak with a registered nurse at no cost to you.
Post Hospital Stay Meals – When you leave the hospital, let us help you stock the refrigerator with nutritious meals. CareFirst CHPMD will provide you with up to 18 nutritious meals, if you are eligible for this service (members recovering from an inpatient stay in a hospital who have no support at home upon discharge).
Over the Counter Medications and Supplies (OTC) – CareFirst CHPMD will provide members with $15 per quarter worth of OTC benefits for items prescribed by a provider. You can use this towards aspirin, cold suppressants, ointments, vitamins, and herbal supplements.
Pregnancy Benefits & Programs
Congratulations! As a CareFirst CHPMD member you are eligible for our Baby Steps your Obstetrics (OB) Wellness Program. Your first prenatal visit should be in your first trimester of pregnancy or within 42 days of enrolling with CareFirst CHPMD.
Services that may be done at your 1st visit:
- Early sonogram to confirm your pregnancy and due date
- Hear your baby’s heartbeat
- Blood work to determine pregnancy risk factors
CareFirst CHPMD provides: prenatal visits, breast pumps, prenatal vitamins, nutrition counseling, support to quit smoking, over the counter medicines and supplies, and hospital stays.
Regular OB visits are important to you and your baby, we can help you schedule them:
- Every 4 weeks for the first 6 months
- Every 2 weeks for the 7th and 8th months
- Every week during the last month
- Frequency of visits is determined by individual needs and assessed risk factors.
Call Member Services and begin your OB care today!
Monday-Friday, 8:00 a.m.–5:00 p.m.
Local: 1-410-779-9369 | Toll-free: 1-800-730-8530 | TTY: 711
Early and Periodic Screening, Diagnosis, and Treatment
These are preventive visits and services for children from birth to age 21 to detect and treat health problems. The goal is to prevent and/or detect health problems early, at age-appropriate intervals, through periodic screenings, visits and testing to make sure your child receives the correct treatment for any problems found.
Call Member Services to help schedule the appointments!
Monday-Friday, 8:00 a.m.–5:00 p.m.
Local: 1-410-779-9369 | Toll-free: 1-800-730-8530 | TTY: 711
Diabetes Prevention Program (DPP)
A program to prevent diabetes in members who are at risk. As a CareFirst CHPMD member you may be eligible for participation in the DPP lifestyle change program.
For more details about the program, please visit Diabetes Prevention Program | CareFirst Community Health Plan Maryland (carefirstchpmd.com)
Virtual PCP Access with CloseKnit
You can choose from thousands of PCPs as a CareFirst CHPMD member, but if you prefer a virtual provider, you can choose CloseKnit. CloseKnit is a virtual-first primary care practice. ‘Virtual-first’ means most illnesses are treated virtually. Instead of going to a doctor’s office, your ‘visit’ is done through an easy-to-use app—anytime, anywhere, 24/7/365. If you need in-person care, they can arrange that for you.
Primary care services include:
- Well care, preventive and urgent care
- Behavioral and mental health support
Register today at https://www.closeknithealth.com/chpmd.