BlueChoice HMO Referral
Small Group Off-SHOP - Maryland

Benefit summaries are now available for the health plans listed below. Please check the site frequently for summary updates.

Please note: Not all services and procedures are covered by your benefits contract. Benefit summaries are for comparison purposes only and does not create rights not given through the benefit plan.

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 SUM7427

SUM7427-SPA
BlueChoice HMO Referral Gold 0 Ded $10/$45/$65/50% (up to $100)/,50% (up to $150) Standard Integrated OOP only SUM7428

SUM7428-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 SUM7429

SUM7429-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 SUM7430

SUM7430-SPA
BlueChoice HMO Referral HSA/HRA Bronze 6200 Ded ON/OFF SHOP D,$15/D,20%/D,40%/D,50% (up to $100)/D,50% (up to $150) HSA/HRA/HDHP Fully Integrated SUM7432

SUM7432-SPA
BlueChoice HMO Referral Bronze 8900 Ded  D,$0/D,$0/D,$0/D,$0/D,$0 HRA Fully Integrated SUM7431

SUM7431-SPA