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.

Spanish benefit summaries are available upon request. Please contact your CareFirst sales representative for more information.

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 Essential Platinum 0

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

Standard

Integrated OOP only

 SUM6998

BlueChoice HMO Essential Gold 500

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

Standard

Integrated OOP only

 SUM6999

BlueChoice HMO Essential Silver 4850

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

Standard

RX Deductible with Integrated OOP

 SUM7006

BlueChoice HMO HSA Bronze 6350

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

HSA

Fully Integrated

 SUM7000

BlueChoice HMO Essential Bronze 7500

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

Standard

RX Deductible with Integrated OOP

 SUM7001

BlueChoice HMO Platinum 0 Ded

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

Standard

Integrated OOP only

 SUM6997

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

 SUM7002

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

 SUM7003

BlueChoice HMO Gold 3000 Ded

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

HRA

RX Deductible with Integrated OOP

 SUM7004

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

 SUM7005

BlueChoice HMO Silver 6500 Ded

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

HRA

RX Deductible with Integrated OOP

 SUM7007

BlueChoice HMO Bronze 6000 Ded

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

HRA

Fully Integrated

 SUM7008

BlueChoice HMO HSA/HRA Gold 1700 Ded

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

HSA/HRA/HDHP

Fully Integrated

 SUM7009

BlueChoice HMO HSA/HRA Silver 1950 Ded

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

HSA/HRA/HDHP

Fully Integrated

 SUM7010

BlueChoice HMO HSA/HRA Silver 2500 Ded

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

HSA/HRA/HDHP

Fully Integrated

 SUM7011

BlueChoice HMO HSA/HRA Silver 3400 Ded

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

HSA/HRA/HDHP

Fully Integrated

 SUM7012

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

 SUM7013