BlueDental Plus and BlueDental Basic Benefit Summaries - Maryland
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.
Plan* | In-Network | Out-of-Network | Annual Max | Dental Summary |
---|---|---|---|---|
1 | 100/80/80/50 | 100/80/80/50 | $1,500 | SUM2580 (No Ortho) SUM2592 (With Ortho) |
2 | 100/80/80/50 | 80/60/60/35 | $1,500 | SUM2581 (No Ortho) SUM2593 (With Ortho) |
3 | 100/80/50/50 | 100/80/50/50 | $1,500 | SUM2582 (No Ortho) SUM2594 (With Ortho) |
4 | 100/80/50/50 | 80/60/35/35 | $1,500 | SUM2583 (No Ortho) SUM2595 (With Ortho) |
5 | 100/80/80/50 | 100/80/80/50 | $2,000 | SUM2584 (No Ortho) SUM2596 (With Ortho) |
6 | 100/80/80/50 | 80/60/60/35 | $2,000 | SUM2585 (No Ortho) SUM2597 (With Ortho) |
7 | 100/80/50/50 | 100/80/50/50 | $2,000 | SUM2586 (No Ortho) SUM2598 (With Ortho) |
8 | 100/80/50/50 | 80/60/35/35 | $2,000 | SUM2587 (No Ortho) SUM2599 (With Ortho) |
* Note: Plan options 1-8 are available as both Employer-Sponsored1 or Voluntary2. Plan options 9-19 are only available as Employer-Sponsored.
Plan* | In-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative) |
Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative) |
Annual Max | Orthodontic Lifetime Maximum | Dental Summary |
---|---|---|---|---|---|
Plan 11,2 | 100/80/80/50 | 100/80/80/50 | $1,500 | N/A | SUM2580 |
$800 | SUM6044 | ||||
$1,000 | SUM6046 | ||||
$1200 | SUM6048 | ||||
$1,500 | SUM2592 | ||||
$2,000 | SUM6050 | ||||
Plan 21,2 | 100/80/80/50 | 80/60/60/35 | $1,500 | N/A | SUM2581 |
$800 | SUM6052 | ||||
$1,000 | SUM6054 | ||||
$1,200 | SUM6056 | ||||
$1,500 | SUM2593 | ||||
$2,000 | SUM6058 | ||||
Plan 31,2 | 100/80/50/50 | 100/80/50/50 | $1,500 | N/A | SUM2582 |
$800 | SUM6076 | ||||
$1000 | SUM6078 | ||||
$1,200 | SUM6080 | ||||
$1,500 | SUM2594 | ||||
$2,000 | SUM6082 | ||||
Plan 41,2 | 100/80/50/50 | 80/60/35/35 | $1,500 | N/A | SUM2583 |
$800 | SUM6084 | ||||
$1000 | SUM6086 | ||||
$1,200 | SUM6088 | ||||
$1,500 | SUM2595 | ||||
$2,000 | SUM6090 | ||||
Plan 51,2 | 100/80/80/50 | 100/80/80/50 | $2,000 | N/A | SUM2584 |
$800 | SUM6060 | ||||
$1000 | SUM6062 | ||||
$1,200 | SUM6064 | ||||
$1,500 | SUM2596 | ||||
$2,000 | SUM6066 | ||||
Plan 61,2 | 100/80/80/50 | 80/60/60/35 | $2,000 | N/A | SUM2585 |
$800 | SUM6068 | ||||
$1000 | SUM6070 | ||||
$1,200 | SUM6072 | ||||
$1,500 | SUM2597 | ||||
$2,000 | SUM6074 | ||||
Plan 71,2 | 100/80/50/50 | 100/80/50/50 | $2,000 | N/A | SUM2586 |
$800 | SUM6092 | ||||
$1000 | SUM6094 | ||||
$1,200 | SUM6096 | ||||
$1,500 | SUM2598 | ||||
$2,000 | SUM6098 | ||||
Plan 81,2 | 100/80/50/50 | 80/60/35/35 | $2,000 | N/A | SUM2587 |
$800 | SUM6100 | ||||
$1000 | SUM6102 | ||||
$1,200 | SUM6104 | ||||
$1,500 | SUM2599 | ||||
$2,000 | SUM6106 | ||||
Plan 91 | 100/80/50/50 | 100/80/50/50 | $1,000 | N/A | SUM5984 |
$800 | SUM5986 | ||||
$1000 | SUM5988 | ||||
$1,200 | SUM5990 | ||||
$1,500 | SUM5992 | ||||
$2,000 | SUM5994 | ||||
Plan 101 | 100/80/80/50 | 100/80/80/50 | $1,000 | N/A | SUM5912 |
$800 | SUM5914 | ||||
$1000 | SUM5916 | ||||
$1,200 | SUM5918 | ||||
$1,500 | SUM5920 | ||||
$2,000 | SUM5922 | ||||
Plan 111 | 100/80/50/50 | 100/80/50/50 | $1,500 | N/A | SUM5996 |
$800 | SUM5998 | ||||
$1000 | SUM6000 | ||||
$1,200 | SUM6002 | ||||
$1,500 | SUM6004 | ||||
$2,000 | SUM6006 | ||||
Plan 121 | 100/80/80/50 | 100/80/80/50 | $1,500 | N/A | SUM5924 |
$800 | SUM5926 | ||||
$1000 | SUM5928 | ||||
$1,200 | SUM5930 | ||||
$1,500 | SUM5932 | ||||
$2,000 | SUM5934 | ||||
Plan 131 | 100/90/60/60 |
100/90/60/60 |
$1,500 | N/A | SUM6008 |
$800 | SUM6010 | ||||
$1000 | SUM6012 | ||||
$1,200 | SUM6014 | ||||
$1,500 | SUM6016 | ||||
$2,000 | SUM6018 | ||||
Plan 141 | 100/90/60/60 | 100/90/60/60 | $1,500 | N/A | SUM6020 |
$800 | SUM6022 | ||||
$1000 | SUM6024 | ||||
$1,200 | SUM6026 | ||||
$1,500 | SUM6028 | ||||
$2,000 | SUM6030 | ||||
Plan 151 | 100/90/90/60 | 100/90/90/60 | $1,500 | N/A | SUM5936 |
$800 | SUM5938 | ||||
$1000 | SUM5940 | ||||
$1,200 | SUM5942 | ||||
$1,500 | SUM5944 | ||||
$2,000 | SUM5946 | ||||
Plan 161 | 100/90/90/60 | 100/90/90/60 | $1,500 | N/A | SUM5948 |
$800 | SUM5950 | ||||
$1000 | SUM5952 | ||||
$1,200 | SUM5954 | ||||
$1,500 | SUM5956 | ||||
$2,000 | SUM5958 | ||||
Plan 171 | 100/90/60/60 | 100/90/60/60 | $2,000 | N/A | SUM6032 |
$800 | SUM6034 | ||||
$1000 | SUM6036 | ||||
$1,200 | SUM6038 | ||||
$1,500 | SUM6040 | ||||
$2,000 | SUM6042 | ||||
Plan 181 | 100/90/90/60 | 100/90/90/60 | $2,000 | N/A | SUM5960 |
$800 | SUM5962 | ||||
$1000 | SUM5964 | ||||
$1,200 | SUM5966 | ||||
$1,500 | SUM5968 | ||||
$2,000 | SUM5970 | ||||
Plan 191 | 100/90/90/60 | 100/90/90/60 | $2,000 | N/A | SUM5972 |
$800 | SUM5974 | ||||
$1000 | SUM5976 | ||||
$1,200 | SUM5978 | ||||
$1,500 | SUM5980 | ||||
$2,000 | SUM5982 |
Plan | In-Network | Out-of-Network | Annual Max | Dental Summary |
---|---|---|---|---|
1 | 100/80/0 | 80/60/0 | $1,000 | SUM2578 (No Ortho) |