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3 11/2005
Blue Direct
is the name of BCBSGa’s Open Access product. Blue Direct members are
required to select a PCP and are encouraged to maintain that relationship. However,
Blue Direct members have the option of accessing specialty care directly through a
BlueChoice HMO Specialty Care Physician without obtaining a prior referral from their
PCP.
Blue Direct members have a specifically labeled member identification card
designating them as Open Access participants. The card will include co-payment
amounts along with the standard benefit information included on all member ID
cards.
Blue Open Access
is the name of BCBSHP’s next generation Open Access product.
Blue Open Access members will not be required to select a Primary Care Physician
(PCP) and will be able to access specialty care through a BlueChoice HMO Specialty
Care Physician without a referral from a PCP. Members will be encouraged to
establish or maintain a relationship with a PCP, since that physician would be most
knowledgeable of the member’s medical history.
Blue Open Access members will have a specifically branded member identification
card designating them as an Open Access participant. The card will include
copayment amounts along with the standard benefit information included on all
member ID cards.
Federal Employee Program (FEP)
The Blue Cross Blue Shield Association, on behalf of
all Blue Cross Blue Shield plans, contracts with the United States Office of Personnel
Management (OPM) to provide Government-Wide Service Benefit Plan coverage to
federal employees and dependents. Blue Cross and Blue Shield of Georgia currently
offers FEP members a choice of either FEP PPO or FEP exclusive provider organization
(EPO) plans to choose for their coverage. An EPO is an exclusive arrangement where
the member must only use preferred providers (similar to an HMO) in order to avoid
out-of-network denials. An EPO does not require a referral for services. If you are
currently a BlueChoice PPO network provider, you would also be able to render
services to FEP members.
National Accounts
A company with locations in more than one Blue Cross Blue Shield
plan area is a national account. These accounts are administered by more than one
Blue Cross Blue Shield plan and have a control plan. Claims for national accounts
administered by Blue Cross and Blue Shield of Georgia are handled through the