Non-Integrated Minimum Value Prescription Options
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.

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.

Formulary 3 Non-Integrated Rx Options

Options for Minimum Value plans only.

Options Features PDF Summary
Option C
(Minimum Value)		 $0 Ded, $15/$35/$60/50% up to $100/50% up to $150 SUM6883
Option E
(Minimum Value)		 $0 Ded, $15/$50/$100/50%/50% SUM4068
Option I
(Minimum Value)		 $500 Ded, $15/$35/$60/50%/50% SUM4072


NOTE: Minimum Value has mandatory generic substitution.