BluePreferred (CDH) Grandfathered/Small Group Non-ACA Benefit Summaries - Virginia

The following BlueFund and Compatible HSA & HRA Plans are BluePreferred based. Whether you choose an option as a BlueFund or Compatible plan, there is no difference in cost.


NOTE: BlueFund Plans integrate with our fund administrator. Compatible Plans do not integrate with a CareFirst fund administrator.

Employers can consult with a CareFirst account executive to explore other plan options that fit their organization's benefit needs.

HSA plans require a combined medical and Rx plan.

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VA 1-50 BluePreferred HSA (Combined Medical & Rx Deductible)

Rx Copay (Options 1-4, 6-7): $0/$25/$45; $10/$25/$45
Rx Copay (Options 8-9): $0/$25/$45


Summary of BluePreferred HSA Combined Rx Plan Options
OptionsFeaturesMedical SummaryRx Summary
Option 3 In: $2,000 Ded; 100% |
Out: $4,000 Ded; 80%		 BRC6493 Options listed above
Option 4 In: $2,700 Ded; 100% |
Out: $5,400 Ded; 80%		 BRC6494 Options listed above
Option 6 In: $1,300 Ded; 100% |
Out: $2,600 Ded; 80%		 SUM1905 Options listed above
Option 7 In: $1,300 Ded; 90% |
Out: $2,600 Ded; 70%		 SUM1908 Options listed above
Option 8 In: $1,500 Ded; 100% |
Out: $3,000 Ded; 80%		 SUM1906 Options listed above
Option 9 In: $1,500 Ded; 90% |
Out: $3,000 Ded; 70%		 SUM1909 Options listed above

VA 1-50 BluePreferred HRA (Combined Medical & Rx Deductible)

Rx Copay (All Options): $0/$25/$45, $10/$25/$45


Summary of BluePreferred HRA Combined Rx Plan Options
OptionsFeaturesMedical SummaryRx Summary
Option 1 In: $1,000 Ded; 100% |
Out: $2,000 Ded; 80%		 BRC6486 Options listed above
Option 2 In: $1,000 Ded; 90% |
Out: $2,000 Ded; 70%		 BRC6487 Options listed above
Option 3 In: $2,000 Ded; 100% |
Out: $4,000 Ded; 80%		 BRC6488 Options listed above
Option 4 In: $3,000 Ded; 100% |
Out: $6,000 Ded; 80%		 BRC6489 Options listed above
Option 5 In: $5,000 Ded; 100% |
Out: $10,000 Ded; 80%		 BRC6490 Options listed above
Option 8 In: $1,500 Ded; 100% |
Out: $3,000 Ded; 80%		 SUM1907 Options listed above
Option 9 In: $1,500 Ded; 90% |
Out: $3,000 Ded; 70%		 SUM1910 Options listed above

VA 1-50 BluePreferred HRA (Separate Medical and Rx Deductibles)

Summary of BluePreferred HRA Separate Rx Plan Options
OptionsFeaturesMedical Summary
Option 1 In: $1,000 Ded; 100% |
Out: $2,000 Ded; 80%		 BRC6481
Option 2 In: $1,000 Ded; 90% |
Out: $2,000 Ded; 70%		 BRC6482
Option 3 In: $2,000 Ded; 100% |
Out: $4,000 Ded; 80%		 BRC6483
Option 4 In: $3,000 Ded; 100% |
Out: $6,000 Ded; 80%		 BRC6484
Option 5 In: $5,000 Ded; 100% |
Out: $10,000 Ded; 80%		 BRC6485

VA 1-50 BluePreferred (Combined Medical & Rx Deductible)

Summary of BluePreferred Combined Rx Plan Options
OptionsFeaturesMedical Summary
Option 1 In: $1,200 Ded; 100% |
Out: $2,400 Ded; 80%		 SUM1960
Option 2 In: $1,200 Ded; 90% |
Out: $2,400 Ded; 70%		 SUM1961

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