Non-Integrated Prescription Options
Mid / Large Group Benefit Summaries - Maryland
Formulary 4 is a streamlined formulary that offers employees a choice of preferred generic and preferred brand drugs. This simplified, two-tier plan provides a lower cost drug option that includes medications from all medically necessary drug classes.
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.
Minimum Value plans have other options.
Options | Features | PDF Summary |
---|---|---|
Option A | $0 Ded., $10/$25/$45/50%/50% | SUM4025 |
Option B | $0 Ded., $0/$50/$75/50%/50% | SUM4026 |
Option C | $0 Ded., $15/$35/$60/50%/50% | SUM4027 |
Option D | $0 Ded., $15/$45/$70/50%/50% | SUM4028 |
Option E | $0 Ded., $15/$50/$100/50%/50% | SUM4029 |
Option F | $100 Ded., $15/$35/$60/50%/50% | SUM4031 |
Option G | $200 Ded., $15/$35/$60/50%/50% | SUM4032 |
Option H | $300 Ded., $15/$35/$60/50%/50% | SUM4033 |
NOTE: These options have restricted generic substitution.
Minimum Value plans have other options.
Options | Features | PDF Summary |
---|---|---|
Option A | $0 Ded., $10/$25 | SUM5383 |
Option B | $0 Ded., $15/$35 | SUM5384 |
Option C | $0 Ded., $20/$60 | SUM5385 |
Option D | $200/$400 Brand Ded., $10/$25 | SUM5386 |
Option E | $200/$400 Brand Ded., $15/$35 | SUM5387 |
Option F | $500/$1,000 Brand Ded., $20/$60 | SUM5388 |
Option G | $100/$200 Ded., $15/$35 | SUM5389 |
Option H | $250/$500 Ded., $15/$35 | SUM5390 |

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