BlueChoice HMO Open Access 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:
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 CUT6708
Option 2 Copay $20/$30 CUT6709
Option 3 Copay $10/$20 CUT6710
Option 4 Copay $5/$10 CUT6711

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Non-MSGR 1-50 
Option Features Brochure Number
Option 1 Copay $5/10 CUT6686 
Option 2 Copay $5/10 CUT6685
Option 3 Copay $10/20 CUT6684
Option 4 Copay $10/20 CUT6683
Option 11 Copay $20/30 CUT6676
Option 12 Copay $30/40 CUT6675
Option 13 Copay $30/40 CUT6674
Option 14 Copay $20/30 CUT6673
Option A Copay $10/20 $500 Ded. CUT6672
Option B Copay $20/30 $500 Ded. CUT6671
Option C Copay $30/40 $500 Ded. CUT6670
Option D Copay $10/20 $500 Ded. CUT6669
Option E Copay $20/30 $500 Ded. CUT6668
Option F Copay $30/40 $500 Ded. CUT6667

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Non-MSGR 51-199
Option Features Brochure Number
Option 1 Copay $5/10 CUT6686 
Option 2 Copay $5/10 CUT6685
Option 3 Copay $10/20 CUT6684
Option 4 Copay $10/20 CUT6683
Option 5 Copay $15/25 CUT6682
Option 6 Copay $15/25 CUT6681
Option 11 Copay $20/30 CUT6676
Option 12 Copay $30/40 CUT6675
Option 13 Copay $30/40 CUT6674
Option 14 Copay $20/30 CUT6673
Option A Copay $10/20 $500 Ded. CUT6672
Option B Copay $20/30 $500 Ded. CUT6671
Option C Copay $30/40 $500 Ded. CUT6670
Option D Copay $10/20 $500 Ded. CUT6669
Option E Copay $20/30 $500 Ded. CUT6668
Option F Copay $20/30 $500 Ded. CUT6667

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District of Columbia 1-50
Option Features Brochure Number
Option 1 Copay $5/10 CUT6688
Option 2 Copay $5/10 CUT6689
Option 3 Copay $10/20 CUT6690
Option 4 Copay $10/20 CUT6691
Option 11 Copay $20/30 CUT6698
Option 12 Copay $30/40 CUT6699
Option 13 Copay $30/40 CUT6700
Option 14 Copay $20/30 CUT6701
Option A Copay $10/20 $500 Ded. CUT6702
Option B Copay $20/30 $500 Ded. CUT6703
Option C Copay $30/40 $500 Ded. CUT6704
Option D Copay $10/20 $500 Ded. CUT6705
Option E Copay $20/30 $500 Ded. CUT6706
Option F Copay $30/40 $500 Ded. CUT6707

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District of Columbia 51-199
Option Features Brochure Number
Option 1 Copay $5/10 CUT6688
Option 2 Copay $5/10 CUT6689
Option 3 Copay $10/20 CUT6690
Option 4 Copay $10/20 CUT6691
Option 5 Copay $15/25 CUT6692
Option 6 Copay $15/25 CUT6693
Option 11 Copay $20/30 CUT6698
Option 12 Copay $30/40 CUT6699
Option 13 Copay $30/40 CUT6700
Option 14 Copay $20/30 CUT6701
Option A Copay $10/20 $500 Ded. CUT6702
Option B Copay $20/30 $500 Ded. CUT6703
Option C Copay $30/40 $500 Ded. CUT6704
Option D Copay $10/20 $500 Ded. CUT6705
Option E Copay $20/30 $500 Ded. CUT6706
Option F Copay $20/30 $500 Ded. CUT6707

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Virginia 1-50 
Option Features Brochure Number
Option 1 Copay $5/10 BRC6459 
Option 2 Copay $5/10 BRC6460
Option 3 Copay $10/20 BRC6461
Option 4 Copay $10/20 BRC6462
Option 11 Copay $20/30 BRC6469
Option 12 Copay $30/40 BRC6470
Option 13 Copay $30/40 BRC6471
Option 14 Copay $20/30 BRC6472
Option A Copay $10/20 $500 Ded. BRC6473
Option B Copay $20/30 $500 Ded. BRC6474
Option C Copay $30/40 $500 Ded. BRC6475
Option D Copay $10/20 $500 Ded. BRC6476
Option E Copay $20/30 $500 Ded. BRC6477
Option F Copay $30/40 $500 Ded. BRC6478

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Virginia 51-199 
Option Features Brochure Number
Option 1 Copay $5/10 BRC6459 
Option 2 Copay $5/10 BRC6460
Option 3 Copay $10/20 BRC6461
Option 4 Copay $10/20 BRC6462
Option 5 Copay $15/25 BRC6463
Option 6 Copay $15/25 BRC6464
Option 11 Copay $20/30 BRC6469
Option 12 Copay $30/40 BRC6470
Option 13 Copay $30/40 BRC6471
Option 14 Copay $20/30 BRC6472
Option A Copay $10/20 $500 Ded. BRC6473
Option B Copay $20/30 $500 Ded. BRC6474
Option C Copay $30/40 $500 Ded. BRC6475
Option D Copay $10/20 $500 Ded. BRC6476
Option E Copay $20/30 $500 Ded. BRC6477
Option F Copay $30/40 $500 Ded. BRC6478

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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 BlueChoice, Inc., an affiliate company, also offers health benefit products and services on this site.

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

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