CareFirst BlueCross BlueShield

BlueChoice HMO Value Silver $2,250 VisionPlus

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    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $2,250
    • Family: $4,500
    • Per Person: $2,250
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $8,050
    • Family: $16,100
    • Per Person: $8,050

    Office Visit

    Primary Doctor
    • CoPay: $30.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    Specialist
    • CoPay: $40.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Prescription Drug Information

    Preferred Brand Drugs
    • CoPay: $50.00 Copay after deductible
    • CoInsurance: Not Applicable
    • Covered: Covered
    Non Preferred Brand Drugs
    • CoPay: $70.00 Copay after deductible
    • CoInsurance: Not Applicable
    • Covered: Covered
    Generic Drugs
    • CoPay: $15.00
    • CoInsurance: Not Applicable
    • Covered: Covered
    Specialty Drugs
    • CoPay: $150.00 Copay after deductible
    • CoInsurance: Not Applicable
    • Covered: Covered

    Inpatient Coverage

    Hospital Services
    • CoPay: Not Applicable
    • CoInsurance: 30.00% Coinsurance after deductible
    • Covered: Covered
    Inpatient Services
    • CoPay: $40.00 Copay after deductible
    • CoInsurance: Not Applicable
    • Covered: Covered

    Emergency and Urgent Care

    Emergency Room
    • CoPay: Not Applicable
    • CoInsurance: 30.00% Coinsurance after deductible
    • Covered: Covered
    Urgent Care Facility
    • CoPay: $60.00
    • CoInsurance: Not Applicable
    • Covered: Covered

    Maternity

    Labor and Delivery Hospital Stay
    • CoPay: Not Applicable
    • CoInsurance: 30.00% Coinsurance after deductible
    • Covered: Covered
    Pre and Postnatal Office Visit
    • CoPay: No Charge
    • CoInsurance: No Charge
    • Covered: Covered

    Vision

    Routine Eye Exams For Children
    • CoPay: No Charge
    • CoInsurance: No Charge
    • 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 : Exam(s) per Benefit Period
    Basic Dental Care - Child
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • Covered: Covered
    Major Dental Care - Child
    • CoPay: Not Applicable
    • CoInsurance: 20.00% Coinsurance after deductible
    • 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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