BlueChoice HMO Referral
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 Referral

Plan Name Rx Plan Type Integration Status Medical Summary

BlueChoice HMO Referral Platinum 0 Ded

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

Standard

Integrated OOP only

 SUM7484

SUM7484-SPA

BlueChoice HMO Referral Gold 0 Ded

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

Standard

Integrated OOP only

 SUM7485

SUM7485-SPA

BlueChoice HMO Referral Gold 800 Ded

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

Standard

RX Deductible with Integrated OOP

 SUM7486

SUM7486-SPA

BlueChoice HMO Referral Silver 5350 Ded

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

HRA

RX Deductible with Integrated OOP

 SUM7487

SUM7487-SPA

BlueChoice HMO Referral Bronze 8900 Ded

D,$0/D,$0/D,$0/D,$0/D,$0

HRA

Fully Integrated

 SUM7488

SUM7488-SPA