BlueChoice HMO
Small Group On-SHOP - District of Columbia

BlueChoice HMO Essential Platinum 0

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

Standard

Integrated OOP only

BlueChoice HMO Essential Gold 500

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

Standard

Integrated OOP only

BlueChoice HMO Essential Silver 4850

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

Standard

RX Deductible with Integrated OOP

BlueChoice HMO HSA Bronze 6350

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

HSA

Fully Integrated

BlueChoice HMO Essential Bronze 7500

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

Standard

RX Deductible with Integrated OOP

BlueChoice HMO Platinum 0 Ded

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

Standard

Integrated OOP only

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

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

BlueChoice HMO Gold 3000 Ded

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

HRA

RX Deductible with Integrated OOP

BlueChoice HMO Silver 2000 Ded

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

HRA

RX Deductible with Integrated OOP

BlueChoice HMO Silver 6900 Ded

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

HRA

RX Deductible with Integrated OOP

BlueChoice HMO Bronze 6000 Ded

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

HRA

Fully Integrated

BlueChoice HMO HSA/HRA Gold 1800 Ded

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

HSA/HRA/HDHP

Fully Integrated

BlueChoice HMO HSA/HRA Silver 2300 Ded

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

HSA/HRA/HDHP

Fully Integrated

BlueChoice HMO HSA/HRA Silver 2650 Ded

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

HSA/HRA/HDHP

Fully Integrated

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

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