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.

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

Plan Name Rx Plan Type Integration Status Medical Summary

BlueChoice HMO Platinum 0 Med Ded 25 Dent Ded

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

Standard

Integrated OOP ONLY

 SUM7951

SUM7951-SPA

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

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

Standard

Rx DEDUCTIBLE W/INTEGRATED OOP

 SUM7952

SUM7952-SPA

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

$10/D,$45/D,$70/D,50% (up to $100)/D,50% (up to $150)

HRA

Rx DEDUCTIBLE W/INTEGRATED OOP

 SUM7953

SUM7953-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

 SUM7954

SUM7954-SPA

BlueChoice HMO Silver 2200 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

 SUM7955

SUM7955-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

 SUM7956

SUM7956-SPA

BlueChoice HMO Bronze 6000 Med Ded 25 Dent Ded

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

HRA

Fully Integrated

 SUM7957

SUM7957-SPA

BlueChoice HMO HSA/HRA Gold 1900 Med Ded 25 Dent Ded

D,$10/D,$45/D,$70/D,50% (up to $100)/D,50% (up to $150)

HSA/HRA/HDHP

Fully Integrated

 SUM7958

SUM7958-SPA

BlueChoice HMO HSA/HRA Silver 2800 Med Ded 25 Dent Ded

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

HSA/HRA/HDHP

Fully Integrated

 SUM7959

SUM7959-SPA

BlueChoice HMO HSA/HRA Silver 3050 Med Ded 25 Dent Ded

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

HSA/HRA/HDHP

Fully Integrated

 SUM7960

SUM7960-SPA

BlueChoice HMO HSA/HRA Silver 3150 Med Ded 25 Dent Ded ON/OFF SHOP

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

HSA/HRA/HDHP

Fully Integrated

 SUM7961

SUM7961-SPA

BlueChoice HMO HSA/HRA Silver 3600 Med Ded 25 Dent Ded

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

HSA/HRA/HDHP

Fully Integrated

 SUM7962

SUM7962-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

 SUM7963

SUM7963-SPA