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BlueChoice HMO Open Access
Mid / Large Group 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.
| Options | Features | Medical Summary | Rx Summary |
|---|---|---|---|
| Option 3 | Copay $10/20 $0 Ded. | BRC6971 | Non-Integrated Rx Options |
| Option 13 | Copay $30/40 $0 Ded. | BRC6981 | Non-Integrated Rx Options |
| Option 14 | Copay $20/30 $0 Ded. | BRC6982 | Non-Integrated Rx Options |
| Option 15 | Copay $20/30 $0 Ded. | SUM5803 | Non-Integrated Rx Options |
| Option 16 | Copay $20/30 $500 Ded. | SUM5804 | Non-Integrated Rx Options |
| Option 17 | Copay $20/30 $1,000 Ded. | SUM5805 | Non-Integrated Rx Options |
| Option 18 | Copay $20/30 $1,500 Ded. | SUM5806 | Non-Integrated Rx Options |
| Option 19 | Copay $20/30 $2,000 Ded. | SUM5807 | Non-Integrated Rx Options |
| Option 20 | Copay $20/30 $2,500 Ded. | SUM5808 | Non-Integrated Rx Options |
| Option B | Copay $20/30 $500 Ded. | BRC6984 | Non-Integrated Rx Options |
| Option C | Copay $30/40 $500 Ded. | BRC6985 | Non-Integrated Rx Options |
| Option I | Copay $30/40 $500 Ded. | BRC6910 | Non-Integrated Rx Options |
| Option J | Copay $30/40 $0 Ded. | BRC6911 | Non-Integrated Rx Options |
| Option K | Copay $20/30 $1,000 Ded. | SUM2687 | Non-Integrated Rx Options |
| Option L | 10% $1,000 Ded. | SUM4714 | Non-Integrated Rx Options |
| Option M | $20/20% $1,000 Ded. | SUM4715 | Non-Integrated Rx Options |
| Option N | Copay $20/40 $1,500 Ded. | SUM4716 | Non-Integrated Rx Options |
| Option O | Copay $20/40 $2,000 Ded. | SUM4717 | Non-Integrated Rx Options |
| Option P | Copay $10/20 $500 Ded. | SUM4718 | Non-Integrated Rx Options |
All plans are fully insured. Please consult with your CareFirst sales representative for information about self-insured options.
| Options | Features | Medical Summary | Rx Summary |
|---|---|---|---|
| Option 1-S | $0 Deductible | SUM3315 | Non-Integrated Rx Options |
| Option 2-S | $500 Deductible | SUM3316 | Non-Integrated Rx Options |
| Option 3-S | $1,000 Deductible | SUM3317 | Non-Integrated Rx Options |
| Option 4-S | $2,000 Deductible | SUM3318 | Non-Integrated Rx Options |
| Option 5-S | $1,500 Deductible | SUM4104 | Non-Integrated Rx Options |
| Option 6-S | $3,000 Deductible | SUM4105 | Non-Integrated Rx Options |
All plans are fully insured. Please consult with your CareFirst sales representative for information about self-insured options.