CareFirst BlueCross BlueShield

BlueChoice HMO Young Adult $8,700

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    Plan Overview

    Combined Medical and Drug Deductible
    • Individual: $8,700
    • Family: $17,400
    • Per Person: $8,700
    Combined Medical and Drug Out of Pocket Maximum
    • Individual: $8,700
    • Family: $17,400
    • Per Person: $8,700

    Office Visit

    Primary Doctor
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    Specialist
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered

    Prescription Drug Information

    Preferred Brand Drugs
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply of Prescription Drugs.
    Non Preferred Brand Drugs
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply of Prescription Drugs.
    Generic Drugs
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply of Prescription Drugs.
    Specialty Drugs
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    • Benefit Explanation: Limited to a 30 day supply of Prescription Drugs.

    Inpatient Coverage

    Hospital Services
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge 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: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered

    Emergency and Urgent Care

    Emergency Room
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    Urgent Care Facility
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered

    Maternity

    Labor and Delivery Hospital Stay
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    Pre and Postnatal Office Visit
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered

    Vision

    Routine Eye Exams For Children
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • 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 after deductible
    • Covered: Covered
    • Limit Quantity: 2
    • Limit Unit : Procedure(s) per Benefit Period
    Basic Dental Care - Child
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge after deductible
    • Covered: Covered
    Major Dental Care - Child
    • CoPay: No Charge after deductible
    • CoInsurance: No Charge 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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