Care First Blue Cross/Blue Shield serves all areas of Washington DC, all areas of Maryland, and all parts of Northern Virginia that are east of Route 123. One of the best new plans available from CareFirst is their new Healthy Blue Triple Option plan, featuring preventative care and primary care office visits at no charge, maternity benefits with no waiting period, a single deductible for the whole family, and no annual limit on prescription drugs.
HealthyBlue Triple Option allows you access to over 26,000 physicians and 60 hospitals in the BlueChoice 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. Option 3 describes out of network benefits (including Blue Cross/Blue Shield providers that are not part of the BlueChoice network).
Deductibles – Option 1 – $1,500 individual, $3,000 for families (one single deductible). Option 2 – $2,000 for individuals, $4,000 for families. Option 3 – $2,500 for individuals, $5,000 for families.
Out of Pocket Maximums – Option 1 – $4,500 individual, $9,000 for families. Option 2 – $6,000 individual, $12,000 for families. Option 3 – $7,500 individual, $15,000 for families.
Office Visits – Option 1 – No charge for primary care visits, $20 co-pay for specialists. Option 2 – No charge for primary care visits, deductible applies for specialist visits, then $100 co-pay. 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.
Diagnostic Services, X-rays, Lab Tests – No charge.
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 (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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