Integrated Prescription Options
Mid / Large Group Benefit Summaries - District of Columbia
Formulary 4 is a streamlined formulary that offers employees a choice of preferred generic and preferred brand drugs. This simplified, two-tier plan provides a lower cost drug option that includes medications from all medically necessary drug classes.
Benefit summaries are now available for the health plans listed below. Please check the site frequently for summary updates.
Spanish benefit summaries are available upon request. Please contact your CareFirst sales representative for more information.
NOTE: Employers can consult with a CareFirst account executive to explore other plan options that fit their organization's benefit needs.
These options do NOT apply to Minimum Value plans or HealthyBlue CDH plans.
Minimum Value and HealthyBlue CDH plans have other options.
|Option A-I||Int Ded., $0/$25/$45/50%/50%||SUM4055|
|Option B-I||Int Ded., $10/$25/$45/50%/50%||SUM4057|
|Option C-I||Int Ded., $15/$35/$60/50%/50%||SUM4058|
|Option D-I||Int Ded., $15/$50/$100/50%/50%||SUM4061|
NOTE: These options have restricted generic substitution.