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BluePreferred (CDH) Grandfathered/Small Group Non-ACA Benefit Summaries - District of Columbia

The following BlueFund and Compatible HSA & HRA Plans are BluePreferred 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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Rx Copay (Options 1-4, 6-7): $0/$25/$45; $10/$25/$45
Rx Copay (Options 8-9): $0/$25/$45


OptionsFeaturesMedical SummaryRx Summary
Option 3 In: $2,000 Ded; 100% |
Out: $4,000 Ded; 80%
CUT6754 Options listed above
Option 4 In: $2,700 Ded; 100% |
Out: $5,400 Ded; 80%
CUT6755 Options listed above
Option 6 In: $1,300 Ded; 100% |
Out: $2,600 Ded; 80%
SUM1914 Options listed above
Option 7 In: $1,300 Ded; 90% |
Out: $2,600 Ded; 70%
SUM1917 Options listed above
Option 8 In: $1,500 Ded; 100% |
Out: $3,000 Ded; 80%
SUM1915 Options listed above
Option 9 In: $1,500 Ded; 90% |
Out: $3,000 Ded; 70%
SUM1918 Options listed above

Rx Copay (All Options): $10/$25/$45, $0/$25/$45


OptionsFeaturesMedical SummaryRx Summary
Option 1 In: $1,000 Ded; 100% |
Out: $2,000 Ded; 80%
CUT6747 Options listed above
Option 2 In: $1,000 Ded; 90% |
Out: $2,000 Ded; 70%
CUT6748 Options listed above
Option 3 In: $2,000 Ded; 100% |
Out: $4,000 Ded; 80%
CUT6749 Options listed above
Option 4 In: $3,000 Ded; 100% |
Out: $6,000 Ded; 80%
CUT6750 Options listed above
Option 5 In: $5,000 Ded; 100% |
Out: $10,000 Ded; 80%
CUT6751 Options listed above
Option 8 In: $1,500 Ded; 100% |
Out: $3,000 Ded; 80%
SUM1916 Options listed above
Option 9 In: $1,500 Ded; 90% |
Out: $3,000 Ded; 70%
SUM1919 Options listed above
OptionsFeaturesMedical Summary
Option 1 In: $1,000 Ded; 100% |
Out: $2,000 Ded; 80%
CUT6742
Option 2 In: $1,000 Ded; 90% |
Out: $2,000 Ded; 70%
CUT6743
Option 3 In: $2,000 Ded; 100% |
Out: $4,000 Ded; 80%
CUT6744
Option 4 In: $3,000 Ded; 100% |
Out: $6,000 Ded; 80%
CUT6745
Option 5 In: $5,000 Ded; 100% |
Out: $10,000 Ded; 80%
CUT6746
OptionsFeaturesMedical Summary
Option 1 In: $1,200 Ded; 100% |
Out: $2,400 Ded; 80%
SUM1956
Option 2 In: $1,200 Ded; 90% |
Out: $2,400 Ded; 70%
SUM1957

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