BlueChoice HMO Referral
Small Group On-SHOP - District of Columbia

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.

BlueChoice HMO Referral

Plan Name Rx Plan Type Integration Status Medical Summary

BlueChoice HMO Referral Platinum 0 Ded

$15/$45/$70/50% (up to $100)/50% (up to $150)

Standard

Integrated OOP only

 SUM7910

SUM7910-SPA

BlueChoice HMO Referral Gold 0 Ded

$20/$45/$70/50% (up to $100)/50% (up to $150)

Standard

Integrated OOP only

 SUM7911

SUM7911-SPA

BlueChoice HMO Referral Gold 800 Ded

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

Standard

RX Deductible with Integrated OOP

 SUM7912

SUM7912-SPA

BlueChoice HMO Referral Silver 5500 Ded

$20/D,$45/D,$75/D,50% (up to $100)/D,50% (up to $150)

HRA

RX Deductible with Integrated OOP

 SUM7913

SUM7913-SPA

BlueChoice HMO Referral Bronze 9700 Ded

D,$0/D,$0/D,$0/D,$0/D,$0

HRA

Fully Integrated

 SUM7914

SUM7914-SPA