DHMO Dental Benefit Summaries - Virginia

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.

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BlueChoice Dental HMO (DHMO) Products

Available ridered to grandfathered BlueChoice medical products only

Summary of BlueChoice Dental HMO Plan Options
Plan Features Dental Summary
Plan 10 Basic Dental Services $10 per office visit BRC6341
Plan 20 Basic Dental Services $20 per office visit BRC6340
Plan 10 Opt-Out Basic Dental Services $10 per office visit,
option to go out-of-network		 BRC6338
Plan 20 Opt-Out Basic Dental Services $20 per office visit,
option to go out-of-network		 BRC6339

Stand-Alone Dental HMO (DHMO) Products

Available for renewals only

Summary of Stand-Alone Dental HMO Plan Options
Options Features Dental Summary
Provider Choice Plan
PC-5		 Basic Dental Services $5 per office visit CUT7390
Provider Choice Plan
PC-10		 Basic Dental Services $10 per office visit CUT7391
Provider Choice Plan
PC-20		 Basic Dental Services $20 per office visit CUT7392
Provider Choice Plan
PC-5 POS		 Basic Dental Services $5 per office visit,
option to go out-of-network		 CUT7387
Provider Choice Plan
PC-10 POS		 Basic Dental Services $10 per office visit,
option to go out-of-network		 CUT7388
Provider Choice Plan
PC-20 POS		 Basic Dental Services $20 per office visit,
option to go out-of-network		 CUT7389

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