BlueChoice HMO Open Access (CDH) Grandfathered/Small Group Non-ACA Benefit Summaries - District of Columbia

The following BlueFund and Compatible HSA & HRA Plans are BlueChoice HMO Open Access based. Whether you choose an option as a BlueFund or Compatible plan, there is no difference in cost.


NOTE: BlueFund Plans integrate with our fund administrator. Compatible Plans do not integrate with a CareFirst fund administrator.

Employers can consult with a CareFirst account executive to explore other plan options that fit their organization's benefit needs.

HSA plans require a combined medical and Rx plan.

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DC 1-50 BlueChoice HMO HSA (Combined Medical & Rx Deductible)

Options Features Medical Summary Rx Summary
Option 2 $2,500 Deductible CUT7011 $0/$25/$45
Option 3 $4,000 Deductible CUT7012 $0/$25/$45
Option 6 $1,300 Deductible SUM1911 $0/$25/$45
Option 7 $1,500 Deductible SUM1912 $0/$25/$45

DC 1-50 BlueChoice HMO HRA (Combined Medical & Rx Deductible)

Options Features Medical Summary
Option 1 $1,200 Deductible SUM1921
Option 2 $2,500 Deductible CUT7011
Option 3 $4,000 Deductible CUT7012
Option 7 $1,500 Deductible SUM1912

DC 1-50 BlueChoice HMO HRA (Separate Medical and Rx Deductibles)

Options Features Medical Summary
Option 1 $1,200 Deductible SUM1921
Option 2 $2,500 Deductible CUT7011
Option 3 $4,000 Deductible CUT7012

DC 1-50 BlueChoice HMO (Combined Medical & Rx Deductible)

Options Features Medical Summary
Option 1 $1,200 Deductible SUM1954

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