BlueFund - Consumer Directed Health Plans (CDH) -
BluePreferred Benefit Summaries

The following BlueFund and Compatible HSA & HRA Plans are BluePreferred based. Whether you choose an option as a BlueFund or Compatible plan, there is no difference in cost.
NOTE: BlueFund Plans integrate with a fund administrator (Mellon Bank) and a plan administrator (FlexAmerica).
  Compatible Plans do not integrate with a CareFirst fund/plan administrator

** Rx Options can be chosen from the standard Rx porfolio.
+ These Rx plans have a 50% coinsurance with a per fill cap of $75

Please select from the following:
Health Reimbursement Account Plans (HRA)
MSGR: HRA
Non-MSGR:
  1-50 Integrated
1-50 Non-Integrated
 51-199 Integrated
51-199 Non-Integrated
District of Columbia:
 

1-50 Integrated
1-50 Non-Integrated

 51-199 Integrated
51-199 Non-Integrated
Virginia:
  1-50 Integrated
1-50 Non-Integrated
 51-199 Integrated
51-199 Non-Integrated
 
Health Savings Account Plans (HSA)
MSGR: HSA
Non-MSGR:
 

1-50

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

MSGR BluePreferred HSA Combined Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 $1,200/$2,400 | 90%/70% CUT6788
Option 2 $2,000/$4,000 | 100%/80%
 CUT6789
Option 3 $2,500/$5,000 | 100%/80% CUT6790
Option 4* $2,750/$5,500 | 80%/60% CUT6949
Option 5 (core) $2,700/$5,450 | 80%/60% CUT6787
Rx Copay Options 1-4: $0/$25/$45+, $15/$25/$50; Option 5: 75% member co-insurance after deductible

*Is available only to existing groups through their 2008 renewal date. Option 4 is not available for new sale effective 10/01/07.

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MSGR BluePreferred HRA Plans (Medical & Rx deductibles are separate**)
Option Features Brochure Number
Option 10 $1,200/$2,400 | 100%/80% CUT6581
Option 11 $2,000/$4,000 | 100%/80% CUT6582

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Non-MSGR 1-50 BluePreferred HSA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,200 Ded; 100% | Out: $2,400 Ded; 80% CUT6738
Option 2 In: $1,200 Ded; 90% | Out: $2,400 Ded; 70% CUT6739
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6740
Option 4 In: $2,700 Ded; 100% | Out: $5,400 Ded; 80% CUT6741
Rx Copay (All Options): $10/$25/$45+, $0/$25/$45

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Non-MSGR 1-50 BluePreferred HRA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% CUT6733
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% CUT6734
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6735
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% CUT6736
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% CUT6737
Rx Copay (All Options): $10/$25/$45+, $0/$25/$45

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Non-MSGR 1-50 BluePreferred HRA Non-integrated Plans (Medical & Rx deductibles are separate**)
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% CUT6728
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% CUT6729
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6730
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% CUT6731
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% CUT6732

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Non-MSGR 51-199 BluePreferred HSA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,200 Ded; 100% | Out: $2,400 Ded; 80% CUT6738
Option 2 In: $1,200 Ded; 90% | Out: $2,400 Ded; 70% CUT6739
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6740
Option 4 In: $2,700 Ded; 100% | Out: $5,400 Ded; 80% CUT6741
Rx Copay (All Options): $0/$25/$45+, $8/$15/$35+; $10/$25/$45+; 30%

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Non-MSGR 51-199 BluePreferred HRA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% CUT6733
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% CUT6734
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6735
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% CUT6736
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% CUT6737
Option 6 In: $1,000 Ded; 80% | Out: $2,000 Ded; 60% CUT6782
Rx Copay (All Options): $0/$25/$45+, $8/$15/$35+; $10/$25/$45+; 30%

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Non-MSGR 51-199 BluePreferred HRA Non-integrated Plans (Medical & Rx deductibles are separate**)
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% CUT6728
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% CUT6729
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6730
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% CUT6731
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% CUT6732
Option 6 In: $1,000 Ded; 80% | Out: $2,000 Ded; 60% CUT6781

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District of Columbia 1-50 BluePreferred HSA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,200 Ded; 100% | Out: $2,400 Ded; 80% CUT6752
Option 2 In: $1,200 Ded; 90% | Out: $2,400 Ded; 70% CUT6753
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6754
Option 4 In: $2,700 Ded; 100% | Out: $5,400 Ded; 80% CUT6755
Rx Copay (All Options): $10/$25/$45+, $0/$25/$45

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District of Columbia 1-50 BluePreferred HRA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% CUT6747
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% CUT6748
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6749
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% CUT6750
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% CUT6751
Rx Copay (All Options): $10/$25/$45+, $0/$25/$45

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District of Columbia 1-50 BluePreferred HRA Non- Integrated Plans (Medical & Rx Deductibles are Separate **)
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% CUT6742
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% CUT6743
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6744
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% CUT6745
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% CUT6746

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District of Columbia 51-199 BluePreferred HSA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,200 Ded; 100% | Out: $2,400 Ded; 80% CUT6752
Option 2 In: $1,200 Ded; 90% | Out: $2,400 Ded; 70% CUT6753
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6754
Option 4 In: $2,700 Ded; 100% | Out: $5,400 Ded; 80% CUT6755
Rx Copay (All Options): , $0/$25/$45+, $8/$15/$35+; $10/$25/$45+; 30%

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District of Columbia 51-199 BluePreferred HRA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% CUT6747
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% CUT6748
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6749
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% CUT6750
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% CUT6751
Option 6 In: $1,000 Ded; 80% | Out: $2,000 Ded; 60% CUT6784
Rx Copay (All Options): $0/$25/$45+, $8/$15/$35+; $10/$25/$45+; 30%

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District of Columbia 51-199 BluePreferred HRA Non- Integrated Plans (Medical & Rx Deductibles are Separate **)
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% CUT6742
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% CUT6743
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 CUT6744
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% CUT6745
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% CUT6746
Option 6 In: $1,000 Ded; 80% | Out: $2,000 Ded; 60% CUT6783

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Virginia 1-50 BluePreferred HSA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,200 Ded; 100% | Out: $2,400 Ded; 80% BRC6491
Option 2 In: $1,200 Ded; 90% | Out: $2,400 Ded; 70% BRC6492
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 BRC6493
Option 4 In: $2,700 Ded; 100% | Out: $5,400 Ded; 80% BRC6494
Rx Copay (All Options): $10/$25/$45+, $0/$25/$45+

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Virginia 1-50 BluePreferred HRA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% BRC6486
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% BRC6487
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 BRC6488
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% BRC6489
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% BRC6490
Rx Copay (All Options): $10/$25/$45+, $0/$25/$45+

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Virginia 1-50 BluePreferred HRA Non- Integrated Plans (Medical & Rx Deductibles are Separate**)
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% BRC6481
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% BRC6482
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 BRC6483
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% BRC6484
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% BRC6485

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Virginia 51-199 BluePreferred HSA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,200 Ded; 100% | Out: $2,400 Ded; 80% BRC6491
Option 2 In: $1,200 Ded; 90% | Out: $2,400 Ded; 70% BRC6492
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 BRC6493
Option 4 In: $2,700 Ded; 100% | Out: $5,400 Ded; 80% BRC6494
Rx Copay (All Options): $0/$25/$45+, $8/$15/$35+; $10/$25/$45+; 30%

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Virginia 51-199 BluePreferred HRA Integrated Medical & Rx Deductible Plans
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% BRC6486
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% BRC6487
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 BRC6488
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% BRC6489
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% BRC6490
Option 6 In: $1,000 Ded; 80% | Out: $2,000 Ded; 60% BRC6506
Rx Copay (All Options): $0/$25/$45+, $8/$15/$35+; $10/$25/$45+; 30%

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Virginia 51-199 BluePreferred HRA Non- Integrated Plans (Medical & Rx Deductibles are Separate **)
Option Features Brochure Number
Option 1 In: $1,000 Ded; 100% | Out: $2,000 Ded; 80% BRC6481
Option 2 In: $1,000 Ded; 90% | Out: $2,000 Ded; 70% BRC6482
Option 3 In: $2,000 Ded; 100% | Out: $4,000 Ded; 80%
 BRC6483
Option 4 In: $3,000 Ded; 100% | Out: $6,000 Ded; 80% BRC6484
Option 5 In: $5,000 Ded; 100% | Out: $10,000 Ded; 80% BRC6485
Option 6 In: $1,000 Ded; 80% | Out: $2,000 Ded; 60% BRC6505

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

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