BlueChoice HMO
Small Group On-SHOP - District of Columbia

Benefit summaries are now available for the health plans listed below. Please check the site frequently for summary updates.

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

BlueChoice HMO

Plan Name Rx Plan Type Integration Status Medical Summary

BlueChoice HMO Platinum 0 Ded

$10/$45/$65/50% (up to $100)/50% (up to $150)

Standard

Integrated OOP only

 SUM6696

BlueChoice HMO Standard Platinum 0

$5/$15/$25/$100/$100

Standard

Integrated OOP only

 SUM6697

BlueChoice HMO Standard Gold 500

$15/$50/$70/$150/$150

Standard

Integrated OOP only

 SUM6698

BlueChoice HMO HSA Standard Bronze 6350

D,20%/D,20%/D,20%/D,20% ($150 max)/D,20% ($150 max)

HSA

Fully Integrated

 SUM6699

BlueChoice HMO Standard Bronze 7500

$25/D,$75/D,$100/D,$150/D,$150

Standard

RX Deductible with Integrated OOP

 SUM6700

BlueChoice HMO Gold 800 Ded

$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

Standard

RX Deductible with Integrated OOP

 SUM6701

BlueChoice HMO Gold 1500 Ded

$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HRA

RX Deductible with Integrated OOP

 SUM6702

BlueChoice HMO Gold 3000 Ded Virtual Connect

$10/D,$40/D,$70/D,$100/D,$150

HRA

RX Deductible with Integrated OOP

 SUM6703

BlueChoice HMO Silver 1900 Ded

$15/D,$50/D,$75/D,50% (up to $100)/D,50% (up to $150)

HRA

RX Deductible with Integrated OOP

 SUM6704

BlueChoice HMO Standard Silver 4850

$20/D,$50/D,$70/D,$100/D,$150

Standard

RX Deductible with Integrated OOP

 SUM6705

BlueChoice HMO Silver 6500 Ded

$15/D,$45/D,$75/D,$100/D,$150

HRA

RX Deductible with Integrated OOP

 SUM6706

BlueChoice HMO Bronze 6000 Ded

D,$20/D,$50/D,$70/D,$100/D,$150

HRA

Fully Integrated

 SUM6707

BlueChoice HMO HSA/HRA Gold 1600 Ded

D,$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM6708

BlueChoice HMO HSA/HRA Silver 1800 Ded

D,$15/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM6709

BlueChoice HMO HSA/HRA Silver 2250 Ded

D,$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM6710

BlueChoice HMO HSA/HRA Silver 3200 Ded

D,$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM6711

BlueChoice HMO HSA/HRA Bronze 6100 Ded

D,$15/D,$45/D,$75/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM6712