|
Medical Benefits |
You Pay |
|
Preventive Services |
|
Adult Physicals (including routine OB/GYN visits) |
$30 per visit (no deductible) |
|
Well-Baby and Child Care (including exams and immunizations) |
$30 per visit (no deductible) |
|
Mammograms, PAP Tests and Prostate Screening & Colorectal Screening |
No Charge |
|
Office Visits, Labs and Testing |
|
Office Visit for Illness |
$30 per visit (after deductible) |
|
X-ray and Lab Tests |
Deductible and Coinsurance |
|
Allergy Testing and Treatment |
Deductible and Coinsurance |
|
Emergency Care |
|
Emergency Room |
Deductible and Coinsurance |
|
Urgent Care Center |
Deductible and Coinsurance |
|
Ambulance (when medically necessary) |
Deductible and Coinsurance |
|
Hospitalization |
|
Inpatient Facility Services |
Deductible and Coinsurance |
|
Inpatient Physician Services |
Deductible and Coinsurance |
|
Outpatient Facility Services |
Deductible and Coinsurance |
|
Outpatient Physician Services |
Deductible and Coinsurance |
| |
|
|
Prescription Drug Benefits* |
|
Deductible |
Combined with medical deductible |
|
Generic Copay |
$10 (after deductible) |
|
Preferred Brand Copay |
$25 (after deductible) |
|
Non-Preferred Brand Copay |
$45 (after deductible) |
CareFirst has made it even easier to manage your costs by combining the medical and prescription deductibles. Money you spend toward covered prescriptions and medical care will go toward meeting the same annual deductible. In addition, all money you pay for medical and prescription costs will go toward meeting the out-of-pocket limit.
Your annual deductible can be met by a combination of family members receiving care, or just one family member receiving care. Once you meet the deductible each year, CareFirst begins paying benefits at the specified coinsurance level.
Care received out-of-network is subject to higher deductibles, coinsurance and out-of-pocket limits.
* There is a 10-month waiting period for coverage on pre-existing conditions.
*Optional (extended) maternity and prenatal benefits may be added for you or your covered spouse. For an additional $126 per month, you'll receive benefits for covered pre- and post-natal care as well as covered services associated with the delivery. If you add maternity coverage, at any time, and you are pregnant on the effective date of your coverage, there will be a 10-month pre-existing condition exclusion period for extended maternity and related services. If you become pregnant after your effective date, then CareFirst will begin covering extended maternity and related services immediately.
* Optional dental and vision benefits may be added to make your coverage even more valuable.
