BlueChoice HMO HSA Silver 3400 VisionPlus Virtual Connect Plus
CareFirst BlueCross BlueShield
Plan overview
Medical deductible
Individual: $3400
Family: $6800
Per Person: $3400
Prescription drug deductible
Individual: $0
Family: $0
Per Person: $0
Combined medical and drug out of pocket maximum
Individual: $6850
Family: $13700
Per Person: $6850
Office visit
Primary Doctor
CoPay:
CoInsurance:
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Specialist
CoPay:
CoInsurance:
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Prescription drug information
Preferred brand drugs
CoPay:
CoInsurance:
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Non preferred brand drugs
CoPay:
CoInsurance:
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Generic drugs
CoPay:
CoInsurance:
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Specialty drugs
CoPay:
CoInsurance:
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Inpatient coverage
Hospital services
CoPay:
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Inpatient services
CoPay:
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Emergency and urgent care
Emergency room
CoPay:
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Urgent care facility
CoPay:
CoInsurance:
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Maternity
Labor and delivery hospital stay
CoPay:
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Pre and Postnatal office visit
CoPay:
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Vision
Routine Eye Exams for Children
CoPay:
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Major dental care
Routine dental checkups for children
CoPay:
CoInsurance:
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Routine dental checkups for adults
CoPay:
CoInsurance:
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Benefit Explanation:
These policies have exclusions, limitations, reduction of benefits, terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable).