| Medical Deductible | - Individual: $1,500
- Family: $3,000
- Per Person: $1,500
|
| Prescription Drug Deductible | - Individual: Included in Medical
- Family: Included in Medical
- Per Person: Included in Medical
|
| Medical Out-of-Pocket Maximum | - Individual: $7,800
- Family: $15,600
- Per Person: $7,800
|
| Drug Out-of-Pocket Maximum | - Individual: Included in Medical
- Family: Included in Medical
- Per Person: Included in Medical
|
Prescription Drug Information
| Preferred Brand Drugs | |
| Non Preferred Brand Drugs | |
| Generic Drugs | |
| Specialty Drugs | |
| Hospital Services | - Standard: 25% Coinsurance after deductible
|
| Inpatient Services | - Standard: 25% Coinsurance after deductible
|
Emergency and Urgent Care
| Emergency Room | - Standard: 25% Coinsurance after deductible
|
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 of Maryland, Inc., Group Hospitalization and Medical Services, Inc. and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Names and Symbols are registered trademarks of the Blue Cross and Blue Shield Association.
1-817-813-4562, TTY 711
