| 58081GA0010024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010021 |
Bronze Classic PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010051 |
Bronze Simple 2 |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010035 |
Gold Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010030 |
Silver Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010015 |
Silver Simple |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010045 |
Silver Simple Diabetes |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Sep 27, 2023 |
| 58081GA0010021 |
Bronze Classic- $0 PCP ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010023 |
Bronze Classic- $3000 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010003 |
Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010024 |
Bronze Classic- $4700 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010005 |
Bronze Elite- $0 Ded+PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010012 |
Bronze Elite- $0 Ded+Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010042 |
Bronze Elite- $1000 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010014 |
Bronze Simple- HSA |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010051 |
Bronze Simple- Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010013 |
Gold Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010035 |
Gold Elite- $0 Ded ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010036 |
Gold Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010017 |
Silver Classic- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010006 |
Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010030 |
Silver Elite- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010028 |
Silver Elite- $0 PCP ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010015 |
Silver Simple ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010045 |
Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010029 |
Silver Simple- HSA |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010025 |
Silver Simple- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010008 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010021 |
Bronze Classic- $0 PCP ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010023 |
Bronze Classic- $3000 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010003 |
Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010024 |
Bronze Classic- $4700 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010040 |
Bronze Classic- $5000 Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010022 |
Bronze Classic- Specialist Saver ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010005 |
Bronze Elite- $0 Ded+PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010012 |
Bronze Elite- $0 Ded+Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010042 |
Bronze Elite- $1000 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010041 |
Bronze Elite ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010014 |
Bronze Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010038 |
Bronze Super Simple ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010034 |
Gold Classic- $0 PCP ($0 Primary Care + $3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010013 |
Gold Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010037 |
Gold Classic- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010020 |
Gold Classic- Low Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010035 |
Gold Elite- $0 Ded ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010036 |
Gold Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010033 |
Gold Simple ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010017 |
Silver Classic- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010006 |
Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010027 |
Silver Classic- Low Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010030 |
Silver Elite- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010028 |
Silver Elite- $0 PCP ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010026 |
Silver Elite- Specialist Saver ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010015 |
Silver Simple ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010045 |
Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010029 |
Silver Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 58081GA0010025 |
Silver Simple- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 58081GA0010008 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
