CareFirst BlueCross BlueShield

BluePreferred PPO Essential Bronze $7500

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

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Plan Overview

Medical Deductible	Individual: $7,500 Family: $15,000 Per Person: $7,500
Prescription Drug Deductible	Individual: $850 Family: $850 Per Person: $850
Medical Out-of-Pocket Maximum	Individual: $9,150 Family: $18,300 Per Person: $9,150
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $45 Copay
Specialist	Standard: $105 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $75 Copay after deductible
Non Preferred Brand Drugs	Standard: $100 Copay after deductible
Generic Drugs	Standard: $25 Copay
Specialty Drugs	Standard: $150 Copay after deductible

Inpatient Coverage

Hospital Services	Standard: 40% Coinsurance after deductible
Inpatient Services	Standard: 40% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: 40% Coinsurance after deductible