BlueChoice Benefit Summaries - Brokers - CareFirst BlueCross BlueShield

BlueChoice Benefit Summaries

The following benefit summaries are now available for small groups (1-50 & 51-199). The information is presented in a printer-friendly, PDF format.* Please check the site frequently for summary updates.

Please select from the following:

MSGR

Non-MSGR: 1-50 & 51-199

District of Columbia: 1-50 & 51-199 Virginia: 1-50 & 51-199

MSGR

Option Features Brochure Number

Option 1 Copay $20/$30; $250 per admission copay CUT5566

Option 2 Copay $20/$30 CUT5567

Option 3 Copay $10/$20 CUT5568

Option 4 Copay $5/$10 CUT5569

Option 5 Copay $30/$40; $250 per admission copay CUT6534

Option 6 Core Copay $30/$40; $1,000 per admission copay CUT6940

top

Non-MSGR 1-50
Option	Features	Brochure Number
Option 1	Copay $5/10	CUT5530
Option 2	Copay $5/10	CUT5531
Option 3	Copay $10/20	CUT5532
Option 4	Copay $10/20	CUT5533
Option 11	Copay $20/30	CUT5914
Option 12	Copay $30/40	CUT6194
Option 13	Copay $30/40	CUT6195
Option 14	Copay $20/30	CUT6390
Option A	Copay $10/20 $500 Ded.	CUT6479
Option B	Copay $20/30 $500 Ded.	CUT6480
Option C	Copay $30/40 $500 Ded.	CUT6481
Option D	Copay $10/20 $500 Ded.	CUT6482
Option E	Copay $20/30 $500 Ded.	CUT6483
Option F	Copay $30/40 $500 Ded.	CUT6484

top

Non-MSGR 51-199
Option	Features	Brochure Number
Option 1	Copay $5/10	CUT5530
Option 2	Copay $5/10	CUT5531
Option 3	Copay $10/20	CUT5532
Option 4	Copay $10/20	CUT5533
Option 5	Copay $15/25	CUT5534
Option 6	Copay $15/25	CUT5445
Option 11	Copay $20/30	CUT5914
Option 12	Copay $30/40	CUT6194
Option 13	Copay $30/40	CUT6195
Option 14	Copay $20/30	CUT6390
Option A	Copay $10/20 $500 Ded.	CUT6479
Option B	Copay $20/30 $500 Ded.	CUT6480
Option C	Copay $30/40 $500 Ded.	CUT6481
Option D	Copay $10/20 $500 Ded.	CUT6482
Option E	Copay $20/30 $500 Ded.	CUT6483
Option F	Copay $30/40 $500 Ded.	CUT6484

top

District of Columbia 1-50
Option	Features	Brochure Number
Option 1	Copay $5/10	CUT5474
Option 2	Copay $5/10	CUT5475
Option 3	Copay $10/20	CUT5476
Option 4	Copay $10/20	CUT5477
Option 11	Copay $20/30	CUT5894
Option 12	Copay $30/40	CUT6192
Option 13	Copay $30/40	CUT6193
Option 14	Copay $20/30	CUT6391
Option A	Copay $10/20 $500 Ded.	CUT6503
Option B	Copay $20/30 $500 Ded.	CUT6504
Option C	Copay $30/40 $500 Ded.	CUT6505
Option D	Copay $10/20 $500 Ded.	CUT6506
Option E	Copay $20/30 $500 Ded.	CUT6507
Option F	Copay $30/40 $500 Ded.	CUT6508

top

District of Columbia 51-199
Option	Features	Brochure Number
Option 1	Copay $5/10	CUT5474
Option 2	Copay $5/10	CUT5475
Option 3	Copay $10/20	CUT5476
Option 4	Copay $10/20	CUT5477
Option 5	Copay $15/25	CUT5488
Option 6	Copay $15/25	CUT5918
Option 11	Copay $20/30	CUT5894
Option 12	Copay $30/40	CUT6192
Option 13	Copay $30/40	CUT6193
Option 14	Copay $20/30	CUT6391
Option A	Copay $10/20 $500 Ded.	CUT6503
Option B	Copay $20/30 $500 Ded.	CUT6504
Option C	Copay $30/40 $500 Ded.	CUT6505
Option D	Copay $10/20 $500 Ded.	CUT6506
Option E	Copay $20/30 $500 Ded.	CUT6507
Option F	Copay $20/30 $500 Ded.	CUT6508

top

Virginia 1-50
Option	Features	Brochure Number
Option 1	Copay $5/10	BRC5996
Option 2	Copay $5/10	BRC5997
Option 3	Copay $10/20	BRC5998
Option 4	Copay $10/20	BRC5999
Option 11	Copay $20/30	BRC6214
Option 12	Copay $30/40	BRC6343
Option 13	Copay $30/40	BRC6344
Option 14	Copay $20/30	BRC6319
Option A	Copay $10/20 $500 Ded.	BRC6392
Option B	Copay $20/30 $500 Ded.	BRC6393
Option C	Copay $30/40 $500 Ded.	BRC6394
Option D	Copay $10/20 $500 Ded.	BRC6395
Option E	Copay $20/30 $500 Ded.	BRC6396
Option F	Copay $30/40 $500 Ded.	BRC6397

top

Virginia 51-199
Option	Features	Brochure Number
Option 1	Copay $5/10	BRC5996
Option 2	Copay $5/10	BRC5997
Option 3	Copay $10/20	BRC5998
Option 4	Copay $10/20	BRC5999
Option 5	Copay $15/25	BRC6000
Option 6	Copay $15/25	BRC6002
Option 11	Copay $20/30	BRC6214
Option 12	Copay $30/40	BRC6343
Option 13	Copay $30/40	BRC6344
Option 14	Copay $20/30	BRC6319
Option A	Copay $10/20 $500 Ded.	BRC6392
Option B	Copay $20/30 $500 Ded.	BRC6393
Option C	Copay $30/40 $500 Ded.	BRC6394
Option D	Copay $10/20 $500 Ded.	BRC6395
Option E	Copay $20/30 $500 Ded.	BRC6396
Option F	Copay $30/40 $500 Ded.	BRC6397

Viewing and printing this document requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.

Report Fraud

Privacy Statement

Site Map

Return to Home Page

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 BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc.

This site is best viewed in IE 5.0 or higher or Netscape 7.0 or higher.