CareFirst Blue Cross/Blue Shield of Washington DC serves all areas of Washington DC, all areas of Maryland, and areas of Northern Virginia that are east of Route 123. The new Healthy Blue Dual-Option HSA plan features preventative care at no charge (in network), maternity benefits with no waiting period, a single deductible for the whole family, and no annual limit on prescription drugs.
HealthyBlue HSA allows you access to over 26,000 physicians and 60 hospitals in the BlueChoice HMO network, and allows you to refer yourself to specialists instead of requiring your primary care doctor to make the referral. If you refer yourself, you pay higher deductibles, co-payments, and maximum out of pocket expenses. Option 1 requires primary care physician referrals, Option 2 does not.
Deductibles – Option 1 – $2,500 individual, $5,000 for families (one single deductible). Option 2 – $3,500 for individuals, $7,000 for families.
Out of Pocket Maximums – Option 1 – $5,000 individual, $10,000 for families. Option 2 – $5,900 individual, $11,800 for families.
Office Visits – No charge after Option 1 deductible. Unlimited visits. Urgent care requires $50 co-pay.
Lifetime Maximum – Unlimited
Preventative Care for Children – No charge
Preventative Care for Adults – No charge
Prescription Drugs – No charge for HealthyBlue Select Generics (tier 1). After deductible, $4 co-pay for tier 1, $45 co-pay for tier 2, $65 co-pay for tier 3. 90-day supplies can be purchased for two times the listed co-pays. Unlimited benefit.
Professional & Diagnostic Services – $20 co-pay after deductible.
Inpatient Services – $300/day co-pay for up to 5 days after deductible for facilities. $20 co-pay after deductible for physician services.
Outpatient Services – $20 co-pay after deductible for facilities, $20 co-pay after deductible for physician services.
Emergency Room Services – $100 co-pay after deductible (waived if admitted)
Maternity – After deductible, $20 co-pay for office visits, $300/day co-pay up to 5 days for delivery and facility services.
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