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The following benefit summaries are 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.
| After May 1, 2005, BlueChoice Opt-Out Plus can only be sold with the Open Access feature. Click on BlueChoice Opt-Out Plus Open Access to order benefit summaries for your groups. The BlueChoice Opt-Out Plus benefit summaries listed below are only available for new employees of existing accounts who have not yet renewed into the BlueChoice Opt-Out Plus Open Access product. |
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| MSGR |
| Option |
Features |
Brochure Number |
| Option 1 |
In: Copay $5/10 | Out: $300/600 Ded., 80%-20% |
CUT5572 |
| Option 2 |
In: Copay $5/10 | Out: $500/1,000 Ded., 80%-20% |
CUT5573 |
| Option 3 |
In: Copay $10/20 | Out: $300/600 Ded., 80%-20% |
CUT5574 |
| Option 4 |
In: Copay $10/20 | Out: $500/1,000 Ded., 80%-20% |
CUT5575 |
| Option 5 |
In: Copay $20/30 | Out: $300/600 Ded., 80%-20% |
CUT5576 |
| Option 6 |
In: Copay $20/30 | Out: $500/1,000 Ded., 80%-20% |
CUT5577 |
top
| Non-MSGR 1-50 |
| Option |
Features |
Brochure Number |
| Option 1 |
In: Copay $5/10 | Out: $300/$600 Ded., 80%-20% |
CUT5535 |
| Option 2 |
In: Copay $5/10 | Out: $500/$1000 Ded., 80%-20% |
CUT5536 |
| Option 3 |
In: Copay $10/20 | Out: $300/$600 Ded., 80%-20% |
CUT5537 |
| Option 4 |
In: Copay $10/20 | Out: $500/$1000 Ded., 80%-20% |
CUT5538 |
| Option 16 |
In: Copay $20/30 | Out: $300/$600 Ded., 80%-20% |
CUT5915 |
| Option 17 |
In: Copay $30/40 | Out: $300/$600 Ded., 80%-20% |
CUT6389 |
| Option A |
Copay $10/20 $500 Ded. |
CUT6497 |
| Option B |
Copay $20/30 $500 Ded. |
CUT6498 |
| Option C |
Copay $30/40 $500 Ded. |
CUT6499 |
| Option D |
Copay $10/20 $500 Ded. |
CUT6500 |
| Option E |
Copay $20/30 $500 Ded. |
CUT6501 |
| Option F |
Copay $30/40 $500 Ded. |
CUT6502 |
top
| Non-MSGR 51-199 |
| Option |
Features |
Brochure Number |
| Option 1 |
In: Copay $5/10 | Out: $300/$600 Ded., 80%-20% |
CUT5535 |
| Option 2 |
In: Copay $5/10 | Out: $500/$1000 Ded., 80%-20% |
CUT5536 |
| Option 3 |
In: Copay $10/20 | Out: $300/$600 Ded., 80%-20% |
CUT5537 |
| Option 4 |
In: Copay $10/20 | Out: $500/$1000 Ded., 80%-20% |
CUT5538 |
| Option 5 |
In: Copay $15/25 | Out: $300/$600 Ded., 80%-20% |
CUT5539 |
| Option 16 |
In: Copay $20/30 | Out: $300/$600 Ded., 80%-20% |
CUT5915 |
| Option 17 |
In: Copay $30/40 | Out: $300/$600 Ded., 80%-20% |
CUT6389 |
| Option A |
Copay $10/20 $500 Ded. |
CUT6497 |
| Option B |
Copay $20/30 $500 Ded. |
CUT6498 |
| Option C |
Copay $30/40 $500 Ded. |
CUT6499 |
| Option D |
Copay $10/20 $500 Ded. |
CUT6500 |
| Option E |
Copay $20/30 $500 Ded. |
CUT6501 |
| Option F |
Copay $30/40 $500 Ded. |
CUT6502 |
top
District of Columbia 1-50
|
| Option |
Features |
Brochure Number |
| Option 1 |
In: Copay $5/10 | Out: $300/$600 Ded., 80%-20% |
CUT5459 |
| Option 2 |
In: Copay $5/10 | Out: $500/$1000 Ded., 80%-20% |
CUT5460 |
| Option 3 |
In: Copay $10/20 | Out: $300/$600 Ded., 80%-20% |
CUT5461 |
| Option 4 |
In: Copay $10/20 | Out: $500/$1000 Ded. 80%-20% |
CUT5546 |
| Option 16 |
In: Copay $20/30 | Out: $300/$600 Ded., 80%-20% |
CUT5895 |
| Option 17 |
In: Copay $30/40 | Out: $300/$600 Ded., 80%-20% |
CUT6388 |
| Option A |
Copay $10/20 $500 Ded. |
CUT6521 |
| Option B |
Copay $20/30 $500 Ded. |
CUT6522 |
| Option C |
Copay $30/40 $500 Ded. |
CUT6523 |
| Option D |
Copay $10/20 $500 Ded. |
CUT6524 |
| Option E |
Copay $20/30 $500 Ded. |
CUT6525 |
| Option F |
Copay $30/40 $500 Ded. |
CUT6526 |
top
| District of Columbia 51-199 |
| Option |
Features |
Brochure Number |
| Option 1 |
In: Copay $5/10 | Out: $300/$600 Ded., 80%-20% |
CUT5459 |
| Option 2 |
In: Copay $5/10 | Out: $500/$1000 Ded., 80%-20% |
CUT5460 |
| Option 3 |
In: Copay $10/20 | Out: $300/$600 Ded., 80%-20% |
CUT5461 |
| Option 4 |
In: Copay $10/20 | Out: $500/$1000 Ded. 80%-20% |
CUT5546 |
| Option 5 |
In: Copay $15/25 | Out: $300/$600 Ded., 80%-20% |
CUT5547 |
| Option 16 |
In: Copay $20/30 | Out: $300/$600 Ded., 80%-20% |
CUT5895 |
| Option 17 |
In: Copay $30/40 | Out: $300/$600 Ded., 80%-20% |
CUT6388 |
| Option A |
Copay $10/20 $500 Ded. |
CUT6521 |
| Option B |
Copay $20/30 $500 Ded. |
CUT6522 |
| Option C |
Copay $30/40 $500 Ded. |
CUT6523 |
| Option D |
Copay $10/20 $500 Ded. |
CUT6524 |
| Option E |
Copay $20/30 $500 Ded. |
CUT6525 |
| Option F |
Copay $30/40 $500 Ded. |
CUT6526 |
top
| Virginia 1-50 |
| Option |
Features |
Brochure Number |
| Option 1 |
In: Copay $5/10 | Out: $300/$600 Ded., 80%-20% |
BRC6016 |
| Option 2 |
In: Copay $5/10 | Out: $500/$1000 Ded., 80%-20% |
BRC6017 |
| Option 3 |
In: Copay $10/20 | Out: $300/$600 Ded., 80%-20% |
BRC6018 |
| Option 4 |
In: Copay $10/20 | Out: $500/$1000 Ded., 80%-20% |
BRC6019 |
| Option 16 |
In: Copay $20/30 | Out: $300/$600 Ded., 80%-20% |
BRC6212 |
| Option 17 |
In: Copay $30/40 | Out: $300/$600 Ded., 80%-20% |
BRC6318 |
| Option A |
Copay $10/20 $500 Ded. |
BRC6410 |
| Option B |
Copay $20/30 $500 Ded. |
BRC6411 |
| Option C |
Copay $30/40 $500 Ded. |
BRC6412 |
| Option D |
Copay $10/20 $500 Ded. |
BRC6413 |
| Option E |
Copay $20/30 $500 Ded. |
BRC6414 |
| Option F |
Copay $30/40 $500 Ded. |
BRC6415 |
top
| Virginia 51-199 |
| Option |
Features |
Brochure Number |
| Option 1 |
In: Copay $5/10 | Out: $300/$600 Ded., 80%-20% |
BRC6016 |
| Option 2 |
In: Copay $5/10 | Out: $500/$1000 Ded., 80%-20% |
BRC6017 |
| Option 3 |
In: Copay $10/20 | Out: $300/$600 Ded., 80%-20% |
BRC6018 |
| Option 4 |
In: Copay $10/20 | Out: $500/$1000 Ded., 80%-20% |
BRC6019 |
| Option 5 |
In: Copay $15/25 | Out: $300/$600 Ded., 80%-20% |
BRC6020 |
| Option 16 |
In: Copay $20/30 | Out: $300/$600 Ded., 80%-20% |
BRC6212 |
| Option 17 |
In: Copay $30/40 | Out: $300/$600 Ded., 80%-20% |
BRC6318 |
| Option A |
Copay $10/20 $500 Ded. |
BRC6410 |
| Option B |
Copay $20/30 $500 Ded. |
BRC6411 |
| Option C |
Copay $30/40 $500 Ded. |
BRC6412 |
| Option D |
Copay $10/20 $500 Ded. |
BRC6413 |
| Option E |
Copay $20/30 $500 Ded. |
BRC6414 |
| Option F |
Copay $30/40 $500 Ded. |
BRC6415 |
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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.
® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc. |
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