| 69803NC0010074 |
AIAN Cost Share |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2025 |
| 69803NC0010075 |
AIAN Cost Share | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2025 |
| 69803NC0010024 |
Bronze Classic 4700 |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010061 |
Bronze Classic 4700 | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010050 |
Bronze Classic Standard |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010055 |
Bronze Classic Standard | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010005 |
Bronze Elite + PCP Saver Plus |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010062 |
Bronze Elite + PCP Saver Plus | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010058 |
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010059 |
Bronze Simple Chronic Care CKM | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010067 |
Bronze Simple Diabetes | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010053 |
Gold Classic Standard |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010057 |
Gold Classic Standard | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010006 |
Silver Classic |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010052 |
Silver Classic Standard |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010056 |
Silver Classic Standard | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010063 |
Silver Classic | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010070 |
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010071 |
Silver Simple Chronic Care CKM | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010045 |
Silver Simple Diabetes |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010064 |
Silver Simple Diabetes | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010025 |
Silver Simple PCP Saver |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010065 |
Silver Simple PCP Saver | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010072 |
Silver Simple Women's Health with Menopause Benefits | with Atrium Health |
2026 |
PREFERRED [PCP] [Dentist]
|
Oct 28, 2025 |
| 69803NC0010024 |
Bronze Classic 4700 |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010061 |
Bronze Classic 4700 | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010050 |
Bronze Classic Standard |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010055 |
Bronze Classic Standard | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010005 |
Bronze Elite + PCP Saver Plus |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010062 |
Bronze Elite + PCP Saver Plus | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010053 |
Gold Classic Standard |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010057 |
Gold Classic Standard | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010035 |
Gold Elite Saver Plus |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010066 |
Gold Elite Saver Plus | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010011 |
Secure |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010060 |
Secure | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010006 |
Silver Classic |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010052 |
Silver Classic Standard |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010056 |
Silver Classic Standard | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010063 |
Silver Classic | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010045 |
Silver Simple Diabetes |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010064 |
Silver Simple Diabetes | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010025 |
Silver Simple PCP Saver |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010065 |
Silver Simple PCP Saver | with Atrium Health |
2025 |
NCN001
|
Jan 10, 2025 |
| 69803NC0010024 |
Bronze Classic 4700 |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010002 |
Bronze Classic PCP Saver |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010050 |
Bronze Classic Standard |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010014 |
Bronze Simple HSA |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010053 |
Gold Classic Standard |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010035 |
Gold Elite Saver Plus |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010011 |
Secure |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010006 |
Silver Classic |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010052 |
Silver Classic Standard |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010030 |
Silver Elite Saver Plus |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010045 |
Silver Simple Diabetes |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010025 |
Silver Simple PCP Saver |
2024 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010003 |
Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010024 |
Bronze Classic 4700 |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010002 |
Bronze Classic PCP Saver |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010050 |
Bronze Classic Standard |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010043 |
Bronze Elite- Deductible Saver Plus ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010012 |
Bronze Elite- Deductible+Specialist Saver Plus ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010014 |
Bronze Simple HSA |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010051 |
Bronze Simple- Standard |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010013 |
Gold Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010053 |
Gold Classic Standard |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010036 |
Gold Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010035 |
Gold Elite Saver Plus |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010011 |
Secure |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010006 |
Silver Classic |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010017 |
Silver Classic- Deductible Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010052 |
Silver Classic Standard |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010030 |
Silver Elite Saver Plus |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010045 |
Silver Simple Diabetes |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010025 |
Silver Simple PCP Saver |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010015 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010021 |
Bronze Classic- $0 PCP ($0 Primary Care + $3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010023 |
Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010003 |
Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010040 |
Bronze Classic- $5000 Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010024 |
Bronze Classic 4700 |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010002 |
Bronze Classic PCP Saver |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010022 |
Bronze Classic- Specialist Saver ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010042 |
Bronze Elite- $1000 Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010041 |
Bronze Elite ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010043 |
Bronze Elite- Deductible Saver Plus ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010012 |
Bronze Elite- Deductible+Specialist Saver Plus ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010001 |
Bronze Simple ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010014 |
Bronze Simple HSA |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010038 |
Bronze Super Simple ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010013 |
Gold Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010037 |
Gold Classic- HSA |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010020 |
Gold Classic- Low Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010036 |
Gold Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010035 |
Gold Elite Saver Plus |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010033 |
Gold Simple ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010011 |
Secure |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010006 |
Silver Classic |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010017 |
Silver Classic- Deductible Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010027 |
Silver Classic- Low Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010028 |
Silver Elite- $0 PCP ($0 Primary Care + $0 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010030 |
Silver Elite Saver Plus |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010026 |
Silver Elite- Specialist Saver ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010008 |
Silver Simple ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010045 |
Silver Simple Diabetes |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010044 |
Silver Simple- High Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010029 |
Silver Simple- HSA |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010025 |
Silver Simple PCP Saver |
2022 |
PREFERRED
|
Oct 10, 2025 |
| 69803NC0010015 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Oct 10, 2025 |
