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BlueChoice HMO
Mid / Large Group Benefit Summaries - District of Columbia
Benefit summaries are now available for the health plans listed below. Please check the site frequently for summary updates.
Please note: Not all services and procedures are covered by your benefits contract. Benefit summaries are for comparison purposes only and does not create rights not given through the benefit plan.
NOTE: Employers can consult with a CareFirst account executive to explore other plan options that fit their organization's benefit needs.
| Options | Features | Medical Summary | Rx Summary |
|---|---|---|---|
| Option 3 | Copay $10/20 $0 Ded. | CUT8605 | Non-Integrated Rx Options |
| Option 13 | Copay $30/40 $0 Ded. | CUT8615 | Non-Integrated Rx Options |
| Option 14 | Copay $20/30 $0 Ded. | CUT8616 | Non-Integrated Rx Options |
| Option 15 | Copay $20/30 $0 Ded. | SUM5775 | Non-Integrated Rx Options |
| Option 16 | Copay $20/30 $500 Ded. | SUM5776 | Non-Integrated Rx Options |
| Option 17 | Copay $20/30 $1,000 Ded. | SUM5777 | Non-Integrated Rx Options |
| Option 18 | Copay $20/30 $1,500 Ded. | SUM5778 | Non-Integrated Rx Options |
| Option 19 | Copay $20/30 $2,000 Ded. | SUM5779 | Non-Integrated Rx Options |
| Option 20 | Copay $20/30 $2,500 Ded. | SUM5780 | Non-Integrated Rx Options |
| Option C | Copay $30/40 $500 Ded. | CUT8619 | Non-Integrated Rx Options |
| Option I | Copay $30/40 $500 Ded. | CUT8422 | Non-Integrated Rx Options |
| Option J | Copay $30/40 $0 Ded. | CUT8423 | Non-Integrated Rx Options |
| Option M | $20/20% $1,000 Ded. | SUM4630 | Non-Integrated Rx Options |
All plans are fully insured. Please consult with your CareFirst sales representative for information about self-insured options.
| Options | Features | Medical Summary | Rx Summary |
|---|---|---|---|
| Option 1-S | $0 Deductible | SUM3291 | Non-Integrated Rx Options |
| Option 2-S | $500 Deductible | SUM3292 | Non-Integrated Rx Options |
| Option 3-S | $1,000 Deductible | SUM3293 | Non-Integrated Rx Options |
| Option 6-S | $3,000 Deductible | SUM4096 | Non-Integrated Rx Options |
All plans are fully insured. Please consult with your CareFirst sales representative for information about self-insured options.
| Options | Features | Medical Summary | Rx Summary |
|---|---|---|---|
| BlueChoice HMO Option MV 1 |
$4,500 Deductible | SUM2695 | Non-Integrated Minimum Value (MV) Rx Options |
| BlueChoice HMO Option MV 2 |
$5,000 Deductible | SUM3295 | Non-Integrated Minimum Value (MV) Rx Options |
| BlueChoice HMO Option MV 3 |
$3,000 Deductible | SUM5095 | Non-Integrated Minimum Value (MV) Rx Options |
| BlueChoice HMO Option MV 4 |
$5,000 Deductible | SUM5096 | Non-Integrated Minimum Value (MV) Rx Options |
| BlueChoice HMO Option MV 5 |
$7,000 Deductible | SUM5097 | Non-Integrated Minimum Value (MV) Rx Options |
| BlueChoice HMO Option MV 6 |
$3,000 Deductible | SUM6900 | Non-Integrated Minimum Value (MV) Rx Options |
All plans are fully insured. Please consult with your CareFirst sales representative for information about self-insured options.