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BlueCare

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BlueCare (HMO)
BlueCare is a health maintenance organization (HMO) plan. That means benefits for covered medical care are only available when members use any of the nearly 4,000 physicians, hospitals and other health professionals that are part of the plan network. Members pay a fixed copayment when receiving covered services, and claim forms are submitted on their behalf. While a Primary Care Physician is recommended, referrals are never required to see specialists. 

PREVENTIVE CARE In-Network YOU PAY
Well child care
Birth through 12 years
All others 

No Charge
OV Copayment 
Periodic, routine health examinations 
OV Copayment 
Routine eye exams  
SV Copayment 
Routine OB/GYN visits 
SV Copayment 
Mammography 
No Charge 
Hearing Screening 
OV Copayment 

MEDICAL CARE In-Network YOU PAY
PCP office visits 
OV Copayment 
Specialist office visits 
SV Copayment 
Outpatient mental health & substance abuse – prior authorization required 
SV Copayment 
Maternity care – initial visit subject to copayment, no charge thereafter 
SV Copayment 
Diagnostic lab, x-ray and testing  
No Charge 
High-cost outpatient diagnostics – prior authorization required. The following are subject to copayment: MRI, MRA, CAT, CTA, PET, SPECT scans 
No Charge OR $75 Copayment per service to $375 calendar year maximum 
Allergy Services
Office visits/testing
Injections – 80 visits in 3 years 

SV Copayment
$25 Copayment 

HOSPITAL CARE – Prior authorization required In-Network YOU PAY
Semi-private room (General/Medical/Surgical/Maternity) 
HSP Copayment 
Skilled nursing facility – up to 120 days per calendar year 
HSP Copayment 
Rehabilitative services – up to 60 days per calendar year 
No Charge 
Outpatient surgery – in a hospital 
OS Copayment 
Ambulatory Surgery – in other than a hospital 
AS Copayment 

EMERGENCY CARE In-Network YOU PAY
Walk-in centers 
OV Copayment 
Urgent care centers – at participating centers only 
UR Copayment 
Emergency care – copayment waived if admitted  
ER Copayment 
Ambulance 
No Charge 

OTHER HEALTH CARE In-Network YOU PAY
Outpatient rehabilitative services
Prior authorization required after the first visit for PT and OT
30 visit maximum for PT, OT, and ST per year. 20 visit maximum for Chiro. per year. 
SV Copayment 
Durable medical equipment / Prosthetic devices
$3000 OR Unlimited maximum per calendar year 
20% OR 50% 
Infertility Services  
Applicable Copayment 
Home Health Care – 200 visit limit per member per calendar year  
No Charge 

Key:
Office Visit (OV) Copayment
Specialist Visit (SV) Copayment
Emergency Room (ER) Copayment 
Outpatient Surgery (OS) Copayment
Hospital (HSP) Copayment
Urgent Care (UR) Copayment
Ambulatory Surgery (AS) Copayment  
 
PREVENTIVE CARE SCHEDULES

Well Child Care (including immunizations) 
6 exams, birth to age 1 
6 exams, ages 1 – 5 
1 exam every 2 years, ages 6 – 10 
1 exam every year, ages 11 – 21 
Adult Exams 
1 exam every 5 years, ages 22 – 29 
1 exam every 3 years, ages 30 – 39 
1 exam every 2 years, ages 40 – 49 
1 exam every year, ages 50+ 

Mammography 
1 baseline screening, ages 35 – 39 
1 screening per year, ages 40+ 
Additional exams when medically necessary 
Vision Exams: 1 exam every 2 calendar years 
 
Hearing Exams: 1 exam per calendar year 
 
OB/GYN Exams: 1 exam per calendar year 
 
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use