Medical & Rx
We offer you a comprehensive benefits program to help you and your family protect your health and financial security. Your benefits are a valuable part of your compensation; we encourage you to learn how your plans work so you can get the most from them.
You have three (3) plan options through CareFirst).
Learn more about your
Medical Plans
Medical Plan Highlights
This is not a complete list of covered services. For more details, please refer to the plan documents.
BlueChoice $1k HMO Plan
In-Network
Plan Availability
Local Employees (DC/MD/VA) Only
Selection of PCP & Referrals Required
Yes
Plan Year Deductible1 (Individual / Family)
$1,000 / $2,000
Your Coinsurance2
(Plan Pays / You Pay)
100% / 0%
Out-of-Pocket Maximum (Individual / Family)
$2,000 / $4,000
Physician Visit5 (Primary Care / Specialist)
$20 / $30 Copay
Preventive Care Services3
Covered 100%
Lab, X-Ray or Other Preventative Tests
No Charge
Major Diagnostics (CT/PET, MRI)
$30 Copay
Hospital Services | Inpatient
Deductible, then $300 Copay
Hospital Services | Outpatient
Deductible, then No Charge
Urgent Care Visit
$50 Copay
Emergency Room Visit
Deductible, then $250 Copay
Out-of-Network
Plan Year Deductible (Individual / Family)
N/A
Your Coinsurance3
(Plan Pays / You Pay)
N/A
Out-of-Pocket Maximum (Individual / Family)
N/A
BlueChoice $0 HMO Plan
In-Network
Plan Availability
Local Employees (DC/MD/VA) Only
Selection of PCP & Referrals Required
Yes
Plan Year Deductible1 (Individual / Family)
$0 / $0
Your Coinsurance2
(Plan Pays / You Pay)
100% / 0%
Out-of-Pocket Maximum (Individual / Family)
$1,000 / $2,000
Physician Visit5 (Primary Care / Specialist)
$20 / $30 Copay
Preventive Care Services3
Covered 100%
Lab, X-Ray or Other Preventative Tests
No Charge
Major Diagnostics (CT/PET, MRI)
$30 Copay
Hospital Services | Inpatient
$300 Copay per Admission
Hospital Services | Outpatient
$300 Copay
Urgent Care Visit
$50 Copay
Emergency Room Visit
$250 Copay
Out-of-Network
Plan Year Deductible (Individual / Family)
N/A
Your Coinsurance3
(Plan Pays / You Pay)
N/A
Out-of-Pocket Maximum (Individual / Family)
N/A
BlueChoice Adv. POS Plan
In-Network
Plan Availability
All Eligible Employees
Selection of PCP & Referrals Required
No
Plan Year Deductible1 (Individual / Family)
$3,000 / $6,000
Your Coinsurance2
(Plan Pays / You Pay)
80% / 20%
Out-of-Pocket Maximum (Individual / Family)
$6,000 / $12,000
Physician Visit5 (Primary Care / Specialist)
$25 / $50 Copay
Preventive Care Services3
Covered 100%
Lab, X-Ray or Other Preventative Tests
Deductible, then 20%
Major Diagnostics (CT/PET, MRI)
Deductible, then 20%
Hospital Services | Inpatient
Deductible, then 20%
Hospital Services | Outpatient
Deductible, then 20%
Urgent Care Visit
$100 Copay
Emergency Room Visit
Deductible, then $250 Copay
Out-of-Network
Plan Year Deductible (Individual / Family)
$6,000 / $12,000
Your Coinsurance3
(Plan Pays / You Pay)
60% / 40%
Out-of-Pocket Maximum (Individual / Family)
$12,000 / $24,000
- The deductible year runs on the plan year (resets on August 1).
- The amount you pay after the deductible is reached. Your coinsurance kicks in once the calendar year deductible is met.
- Preventive care services include but are not limited to routine wellness exams, pelvic exams, pap testing, PSA tests, and immunizations. Covers preventive care services rendered in a physician's office and outpatient service centers.
Prescription (Rx) Plan Design
For more details, please refer to the plan document.
BlueChoice $1k HMO Plan
RETAIL (34-DAY SUPPLY)
Tier 1 - Generic
$15 copay
Tier 2 - Preferred Brand
$35 copay
Tier 3 - Non-Preferred Brand
$60 copay
Tier 4 - Specialty Preferred Brand
50% Coinsurance ($100 max)
Tier 4 - Specialty Non-Preferred Brand
50% Coinsurance ($150 max)
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Generic
$30 copay
Tier 2 - Preferred Brand
$70 copay
Tier 3 - Non-Preferred Brand
$120 copay
Tier 4 - Specialty Preferred Brand
50% Coinsurance ($200 max)
Tier 4 - Specialty Non-Preferred Brand
50% Coinsurance ($300 max)
BlueChoice $0 HMO Plan
RETAIL (34-DAY SUPPLY)
Tier 1 - Generic
$15 copay
Tier 2 - Preferred Brand
$35 copay
Tier 3 - Non-Preferred Brand
$60 copay
Tier 4 - Specialty Preferred Brand
50% Coinsurance ($100 max)
Tier 4 - Specialty Non-Preferred Brand
50% Coinsurance ($150 max)
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Generic
$30 copay
Tier 2 - Preferred Brand
$70 copay
Tier 3 - Non-Preferred Brand
$120 copay
Tier 4 - Specialty Preferred Brand
50% Coinsurance ($200 max)
Tier 4 - Specialty Non-Preferred Brand
50% Coinsurance ($300 max)
BlueChoice Adv. POS Plan
RETAIL (34-DAY SUPPLY)
Tier 1 - Generic
$15 copay
Tier 2 - Preferred Brand
$35 copay
Tier 3 - Non-Preferred Brand
$60 copay
Tier 4 - Specialty Preferred Brand
50% Coinsurance ($100 max)
Tier 4 - Specialty Non-Preferred Brand
50% Coinsurance ($150 max)
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Generic
$30 copay
Tier 2 - Preferred Brand
$70 copay
Tier 3 - Non-Preferred Brand
$120 copay
Tier 4 - Specialty Preferred Brand
50% Coinsurance ($200 max)
Tier 4 - Specialty Non-Preferred Brand
50% Coinsurance ($300 max)
CareFirst Member Benefits
CareFirst My Account
As a CareFirst member, your personalized benefit information is available 24/7. Register for My Account for secure online access to your coverage details, ID cards and more. Plus, you’ll also be able to quickly locate in-network providers and facilities nationwide.
Click the button below for more information and to register
CareFirst Video Visits
With CareFirst Video Visit, you can get the care you need when and where you need it. From sudden colds to allergy woes, simply sign in to connect with a doctor on your smartphone, tablet or computer right away. For other services, schedule a visit and meet with a licensed professional from the comfort of your home. Video Visit doctors will provide you a consultation, diagnosis and even prescriptions (when available and appropriate). They are all U.S. board-certified, licensed and credentialed medical professionals
CareFirst Mobile App
Whether you are traveling for work, family vacation or just taking a road trip, you always have access to your personalized coverage information. Set up your CareFirst mobile access today. Use the CareFirst app to log in anytime, just about anywhere to:
- Find in-network providers and facilities
- View, order or print member ID cards
- Check claims and deductible status
- Update preferences and password
24 Hour Nurse Advice Line
When you have questions about your health, you may not be sure where to go. Instead of waiting and worrying, call the Nurse Advice Line staffed by experienced, registered nurses, 24 hours a day, 7 days a week, 365 days a year. Your nurse will ask a few questions and give you information to help you decide what to do next. Get help to:
- Decide when to visit your doctor or go to a clinic, urgent care center or the emergency room
- Understand your medications
- Find network doctors and prepare for an appointment
- Learn about preventive care
The Nurse Advice Line provides support and guidance for any non-emergency situation. The service is personal, confidential and available at no cost. Call 800-535-9700 anytime, day or night.
Contribution Rates
Pre-Tax Contributions
Payroll Rates
Pre-Tax Contributions
Contact the provider of these benefits by calling this phone number or visiting this website: 855-300-7751, www.carefirst.com