| 40572FL0200024 |
Bronze Classic 4700 |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070024 |
Bronze Classic 4700 |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200024 |
Bronze Classic 4700 |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070024 |
Bronze Classic 4700 |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200055 |
Buena Salud Plateado Estándar Clásico |
2025 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200055 |
Buena Salud Plateado Estándar Clásico |
2025 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070055 |
Buena Salud Plateado Estándar Clásico |
2025 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070055 |
Buena Salud Plateado Estándar Clásico |
2025 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070036 |
Gold Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070036 |
Gold Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070035 |
Gold Elite Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070035 |
Gold Elite Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200016 |
Silver Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070016 |
Silver Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200016 |
Silver Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070016 |
Silver Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070060 |
Silver Simple Chronic Care CKM |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070060 |
Silver Simple Chronic Care CKM |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200060 |
Silver Simple Chronic Care CKM |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200060 |
Silver Simple Chronic Care CKM |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070061 |
Silver Simple Diabetes |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070061 |
Silver Simple Diabetes |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200061 |
Silver Simple Diabetes |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200061 |
Silver Simple Diabetes |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0070025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 18, 2024 |
| 40572FL0200003 |
Bronze Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200003 |
Bronze Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070043 |
Bronze Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200043 |
Bronze Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200043 |
Bronze Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070043 |
Bronze Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070012 |
Bronze Elite + Specialist Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070012 |
Bronze Elite + Specialist Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070013 |
Gold Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070013 |
Gold Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070036 |
Gold Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070036 |
Gold Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070035 |
Gold Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070035 |
Gold Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070006 |
Silver Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070006 |
Silver Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070016 |
Silver Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200016 |
Silver Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200016 |
Silver Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070016 |
Silver Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200030 |
Silver Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200030 |
Silver Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200001 |
Silver Simple |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070015 |
Silver Simple |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070015 |
Silver Simple |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0070025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 40572FL0200003 |
Bronze Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200003 |
Bronze Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070003 |
Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200021 |
Bronze Classic- PCP Saver Plus ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070021 |
Bronze Classic- PCP Saver Plus ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200012 |
Bronze Elite- Deductible+Specialist Saver Plus ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070043 |
Bronze Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070043 |
Bronze Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200043 |
Bronze Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200043 |
Bronze Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070012 |
Bronze Elite + Specialist Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070012 |
Bronze Elite + Specialist Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070014 |
Bronze Simple- HSA |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200014 |
Bronze Simple- HSA |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070051 |
Bronze Simple- Standard |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200051 |
Bronze Simple- Standard |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070013 |
Gold Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070013 |
Gold Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200013 |
Gold Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070036 |
Gold Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070036 |
Gold Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200036 |
Gold Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200035 |
Gold Elite- Deductible Saver Plus ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070035 |
Gold Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070035 |
Gold Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070006 |
Silver Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070006 |
Silver Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200006 |
Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070017 |
Silver Classic- Deductible Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200017 |
Silver Classic- Deductible Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200009 |
Silver Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070009 |
Silver Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200016 |
Silver Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200016 |
Silver Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070016 |
Silver Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070016 |
Silver Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070030 |
Silver Elite- Deductible Saver Plus ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200028 |
Silver Elite- PCP Saver Plus ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070028 |
Silver Elite- PCP Saver Plus ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200030 |
Silver Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200030 |
Silver Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200001 |
Silver Simple |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070015 |
Silver Simple |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070015 |
Silver Simple |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070045 |
Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200045 |
Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200008 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070008 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200003 |
Bronze Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200003 |
Bronze Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070003 |
Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200039 |
Bronze Classic- $4000 Ded ($0 Virtual Primary Care + $3 Drugs) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070039 |
Bronze Classic- $4000 Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200021 |
Bronze Classic- PCP Saver Plus ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070021 |
Bronze Classic- PCP Saver Plus ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200022 |
Bronze Classic- Specialist Saver ($0 Virtual Primary Care + $3 Drugs) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070022 |
Bronze Classic- Specialist Saver ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200042 |
Bronze Elite- $1000 Ded ($0 Virtual Primary Care + $3 Drugs) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070042 |
Bronze Elite- $1000 Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200012 |
Bronze Elite- Deductible+Specialist Saver Plus ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070043 |
Bronze Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070043 |
Bronze Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200043 |
Bronze Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200043 |
Bronze Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070012 |
Bronze Elite + Specialist Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070012 |
Bronze Elite + Specialist Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200004 |
Bronze Simple ($0 Virtual Primary Care + $3 Drugs) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070001 |
Bronze Simple ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200014 |
Bronze Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070014 |
Bronze Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070013 |
Gold Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070013 |
Gold Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070034 |
Gold Classic- $0 PCP ($0 Primary Care + $3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200034 |
Gold Classic- $0 PCP ($0 Virtual Primary Care + $0 Primary Care + $3 Drugs) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200013 |
Gold Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070037 |
Gold Classic- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200037 |
Gold Classic- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200020 |
Gold Classic- Low Ded ($0 Virtual Primary Care + $3 Drugs) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070020 |
Gold Classic- Low Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070036 |
Gold Elite |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070036 |
Gold Elite |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200036 |
Gold Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200035 |
Gold Elite- Deductible Saver Plus ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070035 |
Gold Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070035 |
Gold Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200033 |
Gold Simple ($0 Virtual Primary Care + $3 Drugs) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070033 |
Gold Simple ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070006 |
Silver Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070006 |
Silver Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200006 |
Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070017 |
Silver Classic- Deductible Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200017 |
Silver Classic- Deductible Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200027 |
Silver Classic- Low Ded ($0 Virtual Primary Care + $3 Drugs) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070027 |
Silver Classic- Low Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200009 |
Silver Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070009 |
Silver Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200016 |
Silver Elite |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070016 |
Silver Elite |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070016 |
Silver Elite |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200016 |
Silver Elite |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070030 |
Silver Elite- Deductible Saver Plus ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200028 |
Silver Elite- PCP Saver Plus ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070028 |
Silver Elite- PCP Saver Plus ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200030 |
Silver Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200030 |
Silver Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070015 |
Silver Simple |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070015 |
Silver Simple |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200001 |
Silver Simple |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200045 |
Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070045 |
Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070029 |
Silver Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200029 |
Silver Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0200025 |
Silver Simple PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070025 |
Silver Simple PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0070025 |
Silver Simple PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200025 |
Silver Simple PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 40572FL0200008 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 40572FL0070008 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
