Recent Changes in 2026

• Out-of-Pocket Maximum: The in-network out-of-pocket maximum is increasing from $5,500 to $6,500 for Self Only and from $11,000 to $13,000 for Self+1 and Self and Family. The out-of-network out-of-pocket maximum is increasing from $9,000 to $10,000 for Self Only and from $18,000 to $20,000 for Self+1 and Self and Family.
• Mental Health and Substance Use Disorder: The Office/Outpatient Professional Mental Health and Substance Use Disorder copayments will increase from $0 to $25 in-network and $80 to $100 out-of-network.
• Applied Behavioral Analysis (ABA): The Plan will move coverage for ABA Therapy, from Section 5(a), Habilitative Therapy to Section 5(e), Mental Health and Substance Use Disorder Benefits. The Office/Outpatient Professional member cost share will decrease from a $50 copay to a $25 copay.
• Infertility Services: The Plan will change the coverage for in-vitro fertilization (IVF) from 50% of the plan allowance to Services are paid at regular Plan benefits as outlined in sections 5(a) through 5(f) of the brochure. Limit to three (3) complete egg retrievals and there is no limit on the number of embryo transfers performed from the egg retrieval. In addition, embryo transfer and gamete intra-fallopian transfer (GIFT) and zygote intra-fallopian transfer (ZIFT) are covered if in conjunction with approved IVF benefits. The Plan is eliminating the $45,000 annual limit, the restriction of three attempts per live birth, and the requirement that patients must first attempt less costly infertility treatments before accessing IVF.

• Out-of-Pocket Maximum: The in-network out-of-pocket maximum is increasing from $5,500 to $6,500 for Self Only and from $11,000 to $13,000 for Self+1 and Self and Family. The out-of-network out-of-pocket maximum is increasing from $7,500 to $8,500 for Self Only and from $15,000 to $17,000 for Self+1 and Self and Family.
• Deductible: The Plan will increase the deductible from $1,650 to $1,700 for Self Only and from $3,300 to $3,400 for Self+1 and Self and Family. The out-of-network deductible is increasing from $3,300 to $3,400 for Self Only and from $6,600 to $6,800 for Self+1 and Self and Family.
• Applied Behavioral Analysis (ABA): The Plan will move coverage for ABA Therapy, from Section 5(a), Habilitative Therapy to Section 5(e), Mental Health and Substance Use Disorder Benefits. The office visit copay cost share will decrease from a $35 copay to a $0 copay, deductible applies. The Plan will remove age restrictions.
• Infertility Services: The Plan will change the coverage for in-vitro fertilization (IVF) from 50% of the plan allowance to Services are paid at regular Plan benefits as outlined in sections 5(a) through 5(f) of the brochure. Limit to one IVF cycle per plan year. In addition, embryo transfer and gamete intra-fallopian transfer (GIFT) and zygote intra-fallopian transfer (ZIFT) are covered if in conjunction with approved IVF benefits. The Plan is eliminating the $45,000 annual limit, the restriction of three attempts per live birth, and the requirement that patients must first attempt less costly infertility treatments before accessing IVF.

• Out-of-Pocket Maximum: The in-network out-of-pocket maximum is increasing from $6,500 to $7,500 for Self Only and from $13,000 to $15,000 for Self+1 and Self and Family.
• Applied Behavioral Analysis (ABA): The Plan will move coverage for ABA Therapy, from Section 5(a), Habilitative Therapy to Section 5(e), Mental Health and Substance Use Disorder Benefits. The Office visit copay cost share will decrease from a $50 copay to a $15 copay. The Plan will remove age restrictions.
• Infertility Services: The Plan will change the coverage for in-vitro fertilization (IVF) from 50% of the plan allowance to Services are paid at regular Plan benefits as outlined in sections 5(a) through 5(f) of the brochure. Limit to one IVF cycle per plan year. In addition, embryo transfer and gamete intra-fallopian transfer (GIFT) and zygote intra-fallopian transfer (ZIFT) are covered if in conjunction with approved IVF benefits. The Plan is eliminating the $45,000 annual limit, the restriction of three attempts per live birth, and the requirement that patients must first attempt less costly infertility treatments before accessing IVF.

2026 CareFirst BlueChoice Premiums