CareFirst BlueCross BlueShield

BluePreferred PPO HSA Bronze $6350

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

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Plan Overview

Medical Deductible	Individual: $6,350 Family: $12,700 Per Person: $6,350
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $7,200 Family: $14,400 Per Person: $7,200
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: 20% Coinsurance after deductible
Specialist	Standard: 20% Coinsurance after deductible

Prescription Drug Information

Preferred Brand Drugs	Standard: 20% Coinsurance after deductible
Non Preferred Brand Drugs	Standard: 20% Coinsurance after deductible
Generic Drugs	Standard: 20% Coinsurance after deductible
Specialty Drugs	Standard: 20% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 20% Coinsurance after deductible
Inpatient Services	Standard: 20% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: 20% Coinsurance after deductible