CareFirst BlueCross BlueShield

BlueChoice HMO HSA Standard Bronze $6,350

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    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $6,350
    • Family: $12,700
    • Per Person: $6,350
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $6,900
    • Family: $13,800
    • Per Person: $6,900

    Office Visit

    Primary Doctor
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    Specialist
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered

    Prescription Drug Information

    Preferred Brand Drugs
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply of Prescription Drugs.
    Non Preferred Brand Drugs
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply of Prescription Drugs.
    Generic Drugs
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply of Prescription Drugs.
    Specialty Drugs
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply of Prescription Drugs.

    Inpatient Coverage

    Hospital Services
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    • Benefit Explanation: Prior authorization is required except for emergency admissions and all maternity admissions. Hospitalization solely for rehabilitation limited to ninety (90) days per Benefit Period. Limitations for other reasons are variable and outlined in respective section.
    Inpatient Services
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered

    Emergency and Urgent Care

    Emergency Room
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    Urgent Care Facility
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered

    Maternity

    Labor and Delivery Hospital Stay
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    Pre and Postnatal Office Visit
    • CoPay: Not Applicable
    • CoInsurance: No Charge
    • Covered: Covered

    Vision

    Routine Eye Exams For Children
    • CoPay: $50.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    • Limit Quantity: 1
    • Limit Unit : Exam(s) per Benefit Period

    Major Dental Care

    Routine Dental Checkups for Children
    • CoPay: No Charge
    • CoInsurance: No Charge
    • Covered: Covered
    • Limit Quantity: 2
    • Limit Unit : Procedure(s) per Benefit Period
    Basic Dental Care - Child
    • CoPay: Not Applicable
    • CoInsurance: 20.00%
    • Covered: Covered
    Major Dental Care - Child
    • CoPay: Not Applicable
    • CoInsurance: 20.00%
    • Covered: Covered
    Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc. and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Names and Symbols are registered trademarks of the Blue Cross and Blue Shield Association.
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    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN86052DC0400010ACA1

    © 2024 HealthMarkets Insurance Agency. All rights reserved.

    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN86052DC0400010ACA1

    © 2024 HealthMarkets Insurance Agency. All rights reserved.

    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

    Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

    HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

    This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

    HMPLAN86052DC0400010ACA1