BlueChoice HMO
Small Group Off-SHOP - 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.

BlueChoice HMO

Plan Name Rx Plan Type Integration Status Medical Summary

BlueChoice HMO Platinum 0 Med Ded 25 Dent Ded

$10/$45/$65/50% (up to $100)/50% (up to $150)

Standard

Integrated OOP ONLY

 SUM7056

BlueChoice HMO Gold 800 Med Ded 250 Drug Ded 25 Dent Ded

$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

Standard

Rx DEDUCTIBLE W/INTEGRATED OOP

 SUM7057

BlueChoice HMO Gold 1000 Med Ded 25 Dent Ded SE ON/OFF SHOP

D,$10/D,20%/D,40%/D,50% (up to $100)/D,50% (up to $150)

HRA

Fully Integrated

 SUM7058

BlueChoice HMO Gold 1500 Med Ded 250 Drug Ded 25 Dent Ded

$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HRA

Rx DEDUCTIBLE W/INTEGRATED OOP

 SUM7059

BlueChoice HMO Gold 3000 Med Ded 250 Drug Ded 25 Dent Ded

$10/D,$40/D,$70/D,$100/D,$150

HRA

Rx DEDUCTIBLE W/INTEGRATED OOP

 SUM7060

BlueChoice HMO Silver 1900 Med Ded 250 Drug Ded 25 Dent Ded

$15/D,$50/D,$75/D,50% (up to $100)/D,50% (up to $150)

HRA

Rx DEDUCTIBLE W/INTEGRATED OOP

 SUM7061

BlueChoice HMO Silver 6500 Med Ded 450 Drug Ded 25 Dent Ded

$15/D,$45/D,$75/D,$100/D,$150

HRA

Rx DEDUCTIBLE W/INTEGRATED OOP

 SUM7062

BlueChoice HMO Bronze 6000 Med Ded 25 Dent Ded

D,$20/D,$50/D,$70/D,$100/D,$150

HRA

Fully Integrated

 SUM7063

BlueChoice HMO HSA/HRA Gold 1700 Med Ded 25 Dent Ded

D,$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM7064

BlueChoice HMO HSA/HRA Silver 1950 Med Ded 25 Dent Ded

D,$15/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM7065

BlueChoice HMO HSA/HRA Silver 2500 Med Ded 25 Dent Ded

D,$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM7066

BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE ON/OFF SHOP

D,$10/D,20%/D,40%/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM7067

BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded

D,$10/D,20%/D,40%/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM7068

BlueChoice HMO HSA/HRA Silver 3400 Med Ded 25 Dent Ded

D,$10/D,$45/D,$65/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM7069

BlueChoice HMO HSA/HRA Bronze 6100 Ded Med Ded 25 Dent Ded

D,$15/D,$45/D,$75/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM7070