DHMO Dental Benefit Summaries - Virginia

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.

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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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