BlueAdvantage HMO Plan
A personal doctor. A plan for your routine health care, as well as the unexpected - without complicated paperwork or hassles. Quality, affordability, and ease of use are what you’ll find with our BlueAdvantage HMO plan.
Your PCP Keeps It Simple.
When you enroll, you choose a primary care physician (PCP) from the
HMO Colorado provider network
of internists, pediatricians and family practice doctors. Your PCP provides all preventive care and routine treatment, coordinates non-emergency hospital care and can assist with referrals. Your PCP plays an essential role in the overall coordination of your health care by ensuring consistency and quality of care, and helps to keep your plan affordable and easy to use.
Convenient Copayment Plan Design. You pay a flat amount for some types of care, such as doctor office visits. After your copayment is paid, most services are covered at 100 percent, so you don’t have to worry about meeting deductibles or being surprised with medical bills. When you visit your PCP or an in-network physician specialist, the doctor will also file claims and submit other paperwork for you.
Referral-free Access to Any In-network Specialist.
With our new “open access” policy, you may visit any in-network physician specialist simply by scheduling an appointment. Although you may access in-network specialists directly, we encourage you to use your PCP for the overall coordination and consistency of your care, as well as for referral guidance. Preauthorization is required for some services and procedures. Please see our Referrals and Preauthorization
FAQ for more information.
Please note: Child Health Plan Plus (CHP+) members still must obtain a referral from their PCP for any physician specialist visit.
Worldwide Emergency Care. BlueAdvantage HMO covers you anytime, anywhere, for emergency care. Simply call 911 or go immediately to the nearest emergency facility. You will be responsible for your emergency room copayment, which will be waived if you are admitted to the facility.
Urgent Care. Benefits are provided for visits to urgent care centers, clinics or other facilities for non-emergency, after-hours medical conditions. Urgent care is a convenient alternative when your physician’s office is closed and you need prompt medical attention.
Away from Home CareSM.
When you travel, your health care coverage goes with you. For trips under 90 days, you have access to doctors and hospitals almost everywhere, should your condition require attention before you return home. Call 800-810-BLUE toll free, or visit the BlueCard®
Doctor and Hospital Finder at www.bcbs.com/.
Guest Membership. Courtesy membership is offered when you are residing outside your HMO Colorado service area for 90 days or more. Some states are not included in the program. To apply, call 800-827-6422 toll free.
Benefits: BlueAdvantage HMO Plan
| Preventive and routine care |
| Urgent and emergency care |
| Coverage for hospital treatment and inpatient/outpatient surgery |
| Prescription drugs from nearly all independent and chain-store pharmacies in the state, plus economical mail-order drugs |
| Physical, occupational and speech therapies |
| Home health and hospice care |
| Behavioral/mental health care with alcohol/chemical dependency rehabilitation treatment services, depending on your plan option |
| Chiropractic benefits, depending on your plan option |
If you use one or more specialty medications, learn more about our preferred specialty medication provider PrecisionRx Specialty Solutions. If you are part of a large group (51 or more employees) and your employer has renewed coverage for 2007, you may be required to use PrecisionRx Specialty Solutions to obtain certain specialty medications – click here
to learn more.
Features: BlueAdvantage HMO Plan
In addition to all the basic health plan benefits, such as preventive and routine care, urgent and emergency care and coverage for hospital treatment and surgery, the BlueAdvantage HMO plan offers Anthem Healthy Solutionssm to educate and guide you towards better health:
| Prevention education programs encourage you to have important health screenings, immunizations and regular doctor visits to prevent illness. Programs are also offered for maternity wellness and smoking cessation. |
| Disease management programs are offered for asthma, diabetes, coronary artery disease, congestive heart failure and end-stage renal disease. Anthem also offers a high-risk maternity program for those mothers needing extra guidance. Participation is voluntary and confidential. Call 877-236-7486 toll free for more information. |
| MyAnthem™ This personalized secure member website offers easy, streamlined access to self-service tools and information. Log in and enjoy one-click access to claims and benefits information; search the online provider directory for a doctor or pharmacy; view health and wellness information; use the Healthcare Advisor™ tool to learn about a medical condition and compare hospitals; view drug interactions, drug side effects and more with the PharmaAdvisor™.|
| MyHealth@Anthem and MiSalud@Anthem. These award-winning online health and wellness information resources feature WebMD Personal Health Manager – personalized and interactive tools to help members assess and manage their health, make informed health care decisions and promote healthier lifestyle choices. |
| SpecialOffers@Anthem This site offers convenience and savings on retail products and services. Shop for a personalized weight-loss program; nutrition and alternative wellness products; vitamins; homeopathic and herbal remedies; laser vision correction and contact lenses; smoking cessation products; baby, toddler and maternity products; fitness club membership and fitness equipment; and much more! |
The Strength and Security of Blue
The BlueAdvantage HMO plan is brought to you by HMO Colorado, Inc., a subsidiary of Anthem Blue Cross and Blue Shield. With $16 billion in revenue and more than 12 million plan members across the country, Anthem Blue Cross and Blue Shield is proud to carry on the tradition of bringing you the health plans you prefer from a company you can count on.
As the only licensed Blue Cross and Blue Shield health care benefits insurer in Colorado, Anthem Blue Cross and Blue Shield can offer the strength and security that comes with being one of the largest, most-experienced health insurance organizations in the nation. Nearly one in three Americans enjoys the benefits of coverage from Blue Cross and Blue Shield plans.