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Diabetic Supplies (effective January 1, 2017)
Here is a list of diabetic supplies covered under CareFirst
pharmacy benefits. How diabetic supplies are covered or how much
you have to pay for them depends on your plan. Please check your
benefit materials for the terms of your current drug coverage. For
information on how much you will pay for your diabetic supplies,
log in to My Account (www.carefirst.com/MyAccount) from your
computer, tablet or smartphone and select Check Drug Coverage and
Cost from Quick Links. If you have questions about diabetic
supplies, give us a call at (800) 241-3371.
DIABETIC SUPPLIES Acetone Urine Test Strips
Alcohol Swabs
Glucose Blood Test Disks
Glucose Blood Test Strips
Glucose Urine Test Strips
Glucose Urine Test Tablets
Glucose-Ketones Urine Test Strips
Insulin Pen Needles
Insulin Syringes
Insulin Syringes/Needles
Ketone Blood Test Strips
Lancets This list will be updated periodically. Refer to your
Evidence of Coverage for details. To learn more about your specific
drug benefit, log into My Account at www.carefirst.com/myaccount
and click on Drug & Pharmacy Resources under Quick Links or
call CareFirst Pharmacy Services at 800-241-3371.
CareFirst BlueCross BlueShield is the shared business name of
CareFirst of Maryland, Inc. and Group Hospitalization and Medical
Services, Inc. CareFirst BlueCross BlueShield and CareFirst
BlueChoice, Inc. are both independent licensees of the Blue Cross
and Blue Shield Association.
Registered trademark of the Blue Cross and Blue Shield
Association. Registered trademark of CareFirst of Maryland,
Inc.
2017. All rights reserved. www.carefirst.com SUM2370-1P
(01/01/17 v2)
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CareFirst BlueCross BlueShield is the shared business name of
CareFirst of Maryland, Inc. and Group Hospitalization and Medical
Services, Inc. CareFirst of Maryland, Inc., Group Hospitalization
and Medical Services, Inc., CareFirst BlueChoice, Inc., First Care,
Inc. and The Dental Network are independent licensees of the Blue
Cross and Blue Shield Association. Registered trademark of the Blue
Cross and Blue Shield Association.
Registered trademark of CareFirst of Maryland, Inc.
Notice of Nondiscrimination and Availability of Language
Assistance Services
CareFirst BlueCross BlueShield, CareFirst BlueChoice, Inc. and
all of their corporate affiliates (CareFirst) comply with
applicable federal civil rights laws and do not discriminate on the
basis of race, color, national origin, age, disability or sex.
CareFirst does not exclude people or treat them differently because
of race, color, national origin, age, disability or sex.
CareFirst:
Provides free aid and services to people with disabilities to
communicate effectively with us, such as: o Qualified sign language
interpreters o Written information in other formats (large print,
audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language
is not English, such as: o Qualified interpreters o Information
written in other languages
If you need these services, please call 855-258-6518. If you
believe CareFirst has failed to provide these services, or
discriminated in another way, on the basis of race, color, national
origin, age, disability or sex, you can file a grievance with our
CareFirst Civil Rights Coordinator. Civil Rights Coordinator,
Corporate Office of Civil Rights Telephone Number 410-528-7820
Mailing Address P.O. Box 8894 Baltimore, Maryland 21224
Fax Number 410-505-2011
Email Address [email protected] You can file
a grievance by mail, fax or email. If you need help filing a
grievance, our CareFirst Civil Rights Coordinator is available to
help you. You can also file a civil rights complaint with the U.S.
Department of Health and Human Services, Office for Civil Rights
electronically through the Office for Civil Rights Complaint
portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone
at: U.S. Department of Health and Human Services 200 Independence
Avenue, SW Room 509F, HHH Building Washington, D.C. 20201
800-368-1019, 800-537-7697 (TDD) Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html.
mailto:[email protected]://ocrportal.hhs.gov/ocr/portal/lobby.jsfhttp://www.hhs.gov/ocr/office/file/index.html
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Foreign Language Assistance Attention (English): This notice
contains information about your insurance coverage. It may contain
key dates
and you may need to take action by certain deadlines. You have
the right to get this information and assistance in
your language at no cost. Members should call the phone number
on the back of their member identification card.
All others may call 855-258-6518 and wait through the dialogue
until prompted to push 0. When an agent
answers, state the language you need and you will be connected
to an interpreter.
(Amharic) -
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s dr npas jrr
tt a fi s fn lti t 0. Ngbt aoj kan b dhn, s d t o f a s so p m
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Ting Vit (Vietnamese) Ch : Thng bo ny cha thng tin v phm vi bo
him ca qu v. Thng bo c th
cha nhng ngy quan trng v qu v cn hnh ng trc mt s thi hn nht nh.
Qu v c quyn nhn
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Tagalog (Tagalog) Atensyon: Ang abisong ito ay naglalaman ng
impormasyon tungkol sa nasasaklawan ng iyong
insurance. Maaari itong maglaman ng mga pinakamahalagang petsa
at maaaring kailangan mong gumawa ng
aksyon ayon sa ilang deadline. May karapatan ka na makuha ang
impormasyong ito at tulong sa iyong sariling
wika nang walang gastos. Dapat tawagan ng mga Miyembro ang
numero ng telepono na nasa likuran ng kanilang
identification card. Ang lahat ng iba ay maaaring tumawag sa
855-258-6518 at maghintay hanggang sa dulo ng
diyalogo hanggang sa diktahan na pindutin ang 0. Kapag sumagot
ang ahente, sabihin ang wika na kailangan mo
at ikokonekta ka sa isang interpreter.
Espaol (Spanish) Atencin: Este aviso contiene informacin sobre
su cobertura de seguro. Es posible que
incluya fechas clave y que usted tenga que realizar alguna accin
antes de ciertas fechas lmite. Usted tiene
derecho a obtener esta informacin y asistencia en su idioma sin
ningn costo. Los asegurados deben llamar al
nmero de telfono que se encuentra al reverso de su tarjeta de
identificacin. Todos los dems pueden llamar al
855-258-6518 y esperar la grabacin hasta que se les indique que
deben presionar 0. Cuando un agente de seguros
responda, indique el idioma que necesita y se le comunicar con
un intrprete.
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nia k ke gbo-
kpa-kpa m m dye e ni ii-wuu mu m ke se wii o p. Kpoo ny e m a
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tee wa ke m gbo c m ke
na ma 0 k dyi paain hw. ju ke ny o dyi m g juin, po wuu m m po
dyi, ke ny o mu o niin
ke ni wuu mu za.
(Bengali) : 855-258-6518 0
: (Urdu )
0 6518-258-855
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(Traditional Chinese)
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Igbo (Igbo) Nrbama: kwa a nwere ozi gbasara mkpuchi nchekwa onwe
g. nwere ike nwe bch nd d
mkpa, nwere ike me ihe tupu fd bch njedebe. nwere ikike nweta
ozi na enyemaka a nass g na
akwgh gw bla. Nd otu kwesr kp akara ekwent d naz nke kaad
njirimara ha. Nd z niile nwere
ike kp 855-258-6518 wee chere bb ah ruo mgbe amanyere p 0. Mgbe
onye nnchite anya zara, kwuo
ass chr, a ga-ejik g na onye kwa okwu.
Deutsch (German) Achtung: Diese Mitteilung enthlt Informationen
ber Ihren Versicherungsschutz. Sie kann
wichtige Termine beinhalten, und Sie mssen gegebenenfalls
innerhalb bestimmter Fristen reagieren. Sie haben
das Recht, diese Informationen und weitere Untersttzung
kostenlos in Ihrer Sprache zu erhalten. Als Mitglied
verwenden Sie bitte die auf der Rckseite Ihrer Karte angegebene
Telefonnummer. Alle anderen Personen rufen
bitte die Nummer 855-258-6518 an und warten auf die
Aufforderung, die Taste 0 zu drcken. Geben Sie dem
Mitarbeiter die gewnschte Sprache an, damit er Sie mit einem
Dolmetscher verbinden kann.
Franais (French) Attention: cet avis contient des informations
sur votre couverture d'assurance. Des dates
importantes peuvent y figurer et il se peut que vous deviez
entreprendre des dmarches avant certaines chances.
Vous avez le droit d'obtenir gratuitement ces informations et de
l'aide dans votre langue. Les membres doivent
appeler le numro de tlphone figurant l'arrire de leur carte
d'identification. Tous les autres peuvent appeler le
855-258-6518 et, aprs avoir cout le message, appuyer sur le 0
lorsqu'ils seront invits le faire. Lorsqu'un(e)
employ(e) rpondra, indiquez la langue que vous souhaitez et vous
serez mis(e) en relation avec un interprte.
(Korean) : . .
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855-258-6518 0 .
.
CareFirst Diabetic Supplies 1.1.17DIABETIC SUPPLIES
Final Notice and Tagline Doc Branded V 1.12