Domestic Health and Prescription Plan and Rate

Plan Basics:

An eligible employee has the option to choose between any one of the 4 plan options. There is an “Executive Summary” which follows for each plan, and additionally, there is a full benefit summary available by clicking the link following each Executive Summary.

If you would like to see the latest list of doctors in the CareFirst HMO or PPO Network, here is the website: www.carefirst.com.

The following sections include comments which may help you decide on the best option to suit your needs:

Blue Choice HMO Open Access HSA Option 4 is a plan which utilizes the local CareFirst HMO network. Services must be provided by a network member in order to qualify for benefits. Also important to note is that this plan involves a Health Savings Account (HSA) feature. This means that there is a large deductible which must be satisfied prior to being eligible for most benefits, including prescriptions. For more information about an HSA type of plan, please review this dated, but effective Treasury HSA Brochure. This is the lowest premium plan.

Blue Choice Opt Out Plus Open Access Option 3 is a Point of Service plan that uses the local CareFirst HMO network. Under a Point of Service plan, you may qualify for benefits whether or not your physician is a member of the CareFirst HMO network. Benefits are better when care and treatment is received from a network provider. You may be responsible for paying the balance of the bill to out of network providers that do not accept the CareFirst reimbursement as full payment. This plan does not have a deductible which needs to be satisfied prior to being eligible for benefits.

Blue Choice Advantage Option 1-S operates very much like a Point of Service plan with one additional feature. For anyone seeking services outside of the Metro DC CareFirst network area, providers who are members of the local Blue Cross Blue Shield PPO Network may be accessed and claims will be processed as In Network under this plan. If you or a dependent on your plan lives outside of the Metro DC Blue Choice network area, this plan is a lower cost alternative compared to the PPO.

Blue Preferred PPO Option 6 is a plan that uses the Blue Cross Preferred Provider Organization national network. With this PPO plan, you may receive benefits whether or not your service provider is a member of the CareFirst/Blue Cross PPO network. This plan is the most flexible of all the plans offered, and is also the most expensive in terms of monthly premiums. This plan also covers participants nationwide under the Blue Cross PPO network.

Please refer to the links below for more descriptive benefit summaries for the above referenced plans.

• Summary of Benefits for Blue Choice HMO Option 4
• Summary of Benefits for Blue Choice Opt Out Plus Open Access Option 3
• Summary of Benefits for Blue Choice Advantage Option 1-S
• Summary of Benefits for Blue Preferred PPO 6
• Summary of Benefits Rx for HMO
• Summary of Benefits Rx for POS and PPO
• Blue Preferred Option 6 policy
• Blue Choice Opt Out Open Access Option 3 policy 
• Blue Choice HMO Open Access HSA Option 4 policy
• Blue Choice Advantage Option 1-S

2024-2025 CareFirst

Overseas Building Operations & USAID PSC Healthplan

Domestic Plan Rate Chart

4
	Carefirst Blue Choice Opt Out Plus Open Access Option 3	Carefirst Blue Choice HMO Open Access HSA Option 4		Carefirst Blue Preferred PPO Option 6	Carefirst Blue Choice Advantage Option 1-S	Carefirst Traditional Dental Option 4
Employee/Single	$880.22	$764.41		$1059.60	$890.10	$43.34
Per Pay Period	$440.11	$382.21		$529.80	$445.05	$21.67
Employee & Spouse	$2024.72	$1758.46		$2437.58	$2047.61	$99.68
Per Pay Period	$1012.36	$879.23		$1218.79	$1023.81	$49.84
Employee & Child	$1627.40	$1413.98		$1959.25	$1645.79	$80.18
Per Pay Period	$813.70	$706.99		$979.63	$822.90	$40.09
Family	$2463.88	$2139.31		$2966.59	$2492.00	$121.35
Per Pay Period	$1231.94	$1069.66		$1483.30	$1246.00	$60.68