36 of the provider. Outside the 25-mile radius surrounding your home, the Plan’s normal network provider coverage applies. Hospital Assigned Services Whenever possible, you should advise your hospital and your attending physician of your need to use CareFirst Administrators providers for all referral services. However, if you receive services from a CareFirst Administrators participating hospital, and the hospital makes a referral to a non-participating provider, benefits for covered services will be provided at the in-network level. This standard will apply when your participating hospital assigns you a non-participating anesthesiologist or Emergency Room Physician or refers your lab tests or x-rays to a non-participating pathologist or radiologist for interpretation. This standard also will apply if your participating surgeon selects a non-participating assistant surgeon, or if your participating physician asks a non-participating physician or Specialist to see you at the hospital. Travel Employees (Applies to IAM&AW Grand Lodge Active Employees covered under Plan A+ only) If you, as an Employee of the Grand Lodge of the IAM&AW, are identified by the Employer as a “Travel Employee”, regardless of the time-period of the travel assignment, benefits will be provided at the “In- Network” level for any covered provider, regardless of network participation. This feature is not available to any family member other than to the Employee identified as a “Travel Employee” by the Grand Lodge, or to Employees of any other contributing Employer. However, if you wish to incur the lowest possible out-of-pocket expenses, you should always consider seeking out an CareFirst Administrators network provider, even when you are away from home on business for the Employer, by calling Quantum Health’s toll-free care line, 1-866-871-0839, for assistance in finding a participating provider, or by using the cfablue.com website or telephone app. Opportunity to Select a Primary Care Physician Under the terms of the Plan, you are not required to select a Primary Care Physician (PCP), but may do so if you wish. You may use CareFirst Administrators network to select a Primary Care Physician for yourself, your Spouse, and/or your Eligible Dependent Child. The role of the PCP is to provide or arrange for medical care. Whether you select a PCP or not, you, your Spouse, and/or your Eligible Dependent child may exercise their choice of other health care providers without authorization from the PCP to provide the covered services they need, including Specialists. Each individual covered under the Plan has the right to select a PCP from CareFirst Administrator’s list, and such PCP may be different for each covered individual. Quantum Health’s Toll-Free Care Line Quantum Health’s toll-free care line allows you to talk to a health professional between 8:30am and 10:00pm, Monday - Friday, by calling the toll-free number shown on the back of your identification card at 1-866-871-0839. The staff at Quantum Health’s toll-free care line can provide you with names of Quantum Health participating providers. You, your Spouse, and/or your Eligible Dependent Child may call Quantum Health’s toll-free number if you need medical care. The staff will assist you with the available options.
BTF Summary Plan A/A+ Page 40 Page 42