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

 SUM7526

SUM7526-SPA

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

 SUM7527

SUM7527-SPA

BlueChoice HMO Gold 1100 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

 SUM7528

SUM7528-SPA

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

 SUM7529

SUM7529-SPA

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

 SUM7530

SUM7530-SPA

BlueChoice HMO Silver 2000 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

 SUM7531

SUM7531-SPA

BlueChoice HMO Silver 6900 Med Ded 450 Drug Ded 25 Dent Ded

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

HRA

Rx DEDUCTIBLE W/INTEGRATED OOP

 SUM7532

SUM7532-SPA

BlueChoice HMO Bronze 6000 Med Ded 25 Dent Ded

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

HRA

Fully Integrated

 SUM7533

SUM7533-SPA

BlueChoice HMO HSA/HRA Gold 1800 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

 SUM7534

SUM7534-SPA

BlueChoice HMO HSA/HRA Silver 2300 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

 SUM7535

SUM7535-SPA

BlueChoice HMO HSA/HRA Silver 2650 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

 SUM7536

SUM7536-SPA

BlueChoice HMO HSA/HRA Silver 3000 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

 SUM7537

SUM7537-SPA

BlueChoice HMO HSA/HRA Silver 3000 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

 SUM7538

SUM7538-SPA

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

 SUM7539

SUM7539-SPA

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

 SUM7540

SUM7540-SPA