2010 Medicare Part D Contract ID/Plan ID Search
This is archive material for research purposes. Please see
PDPFinder.com or
MAFinder.com for current plans.
Enter a Contract ID and Plan ID
| 2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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| Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
| Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details 
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Apache | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Cochise | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Coconino | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Graham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Greenlee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Maricopa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Mohave | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Navajo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Pima | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Pinal | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Santa Cruz | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AZ - H0540-001-0 Benefit Details
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Yavapai | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Ashley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Baxter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Benton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Boone | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Bradley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Carroll | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Cleveland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Conway | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Craighead | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Crawford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Crittenden | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Dallas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Faulkner | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Fulton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Howard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Lincoln | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Logan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Lonoke | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Marion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Miller | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Nevada | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Newton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Ouachita | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Perry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Phillips | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Pope | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Pulaski | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Randolph | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Scott | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Searcy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Sebastian | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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St. Francis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Stone | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Union | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Van Buren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in AR - H0540-001-0 Benefit Details
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Woodruff | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Adams | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Alexander | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Bond | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Boone | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Brown | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Bureau | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Calhoun | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Carroll | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Cass | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Champaign | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Clark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Clay | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Clinton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Coles | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Crawford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Cumberland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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DeKalb | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
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Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Edgar | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Edwards | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Effingham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Ford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Fulton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Gallatin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
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|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Greene | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Hamilton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Hancock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Hardin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Henry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Jasper | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Jo Daviess | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Kankakee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Kendall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
La Salle | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Logan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Macon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Macoupin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Marshall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Mason | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Massac | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
McDonough | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
McLean | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Menard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Mercer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Morgan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Moultrie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Ogle | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Peoria | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Piatt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Pike | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Pope | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Pulaski | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Richland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Rock Island | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Saline | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Sangamon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Schuyler | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Scott | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Shelby | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
St. Clair | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Stark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Stephenson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Tazewell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Union | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Vermilion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Warren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
White | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Whiteside | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Williamson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Winnebago | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IL - H0540-001-0 Benefit Details
|
Woodford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Adams | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Allen | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Benton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Brown | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Carroll | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
De Kalb | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Dearborn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Decatur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Dubois | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Elkhart | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Fayette | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Fulton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Gibson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Hamilton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Harrison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Hendricks | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Huntington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Jay | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Kosciusko | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Lagrange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Marshall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Martin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Morgan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Newton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Noble | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Ohio | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Owen | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Posey | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Pulaski | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Ripley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Scott | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
St. Joseph | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Union | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Vanderburgh | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Wabash | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Warrick | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Wells | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IN - H0540-001-0 Benefit Details
|
Whitley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Adair | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Adams | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Allamakee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Appanoose | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Audubon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Benton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Boone | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Bremer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Buena Vista | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Butler | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Calhoun | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Carroll | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Cass | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Cedar | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Cerro Gordo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Cherokee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Chickasaw | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Clarke | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Clay | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Clayton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Clinton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Crawford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Dallas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Davis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Decatur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Delaware | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Des Moines | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Dickinson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Dubuque | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Emmet | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Fayette | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Floyd | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Fremont | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Greene | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Grundy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Guthrie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Hamilton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Hancock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Hardin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Harrison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Henry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Howard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Humboldt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Ida | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Iowa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Jasper | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Jones | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Keokuk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Kossuth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Linn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Louisa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Lucas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Lyon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Mahaska | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Marion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Marshall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Mills | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Mitchell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Muscatine | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
O'Brien | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Osceola | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Page | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Palo Alto | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Plymouth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Pocahontas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Pottawattamie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Poweshiek | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Ringgold | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Sac | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Scott | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Sioux | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Story | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Tama | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Taylor | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Union | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Van Buren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Wapello | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Warren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Webster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Winnebago | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Winneshiek | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Woodbury | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in IA - H0540-001-0 Benefit Details
|
Worth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Bath | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Bourbon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Campbell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Carter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Clark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Elliott | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Estill | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Fayette | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Harrison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Henry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Jessamine | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Kenton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Lincoln | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Marion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Menifee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Mercer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Metcalfe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Morgan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Pendleton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Powell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Pulaski | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Rockcastle | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Rowan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Russell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Scott | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Shelby | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Webster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KY - H0540-001-0 Benefit Details
|
Woodford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Allen | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Ascension | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Assumption | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Avoyelles | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Bossier | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Calcasieu | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Caldwell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Cameron | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Catahoula | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
De Soto | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
East Baton Rouge | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
East Carroll | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
East Feliciana | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Iberville | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Lafourche | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Livingston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Morehouse | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Orleans | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Plaquemines | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Pointe Coupee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Rapides | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
St. Bernard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
St. Charles | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
St. James | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
St. John the Baptist | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
St. Mary | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Terrebonne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Vernon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
West Baton Rouge | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in LA - H0540-001-0 Benefit Details
|
Winn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Berkshire | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Bristol | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Dukes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Essex | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Hampden | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Hampshire | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Middlesex | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Norfolk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Plymouth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Suffolk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MA - H0540-001-0 Benefit Details
|
Worcester | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Alcona | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Allegan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Barry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Benzie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Berrien | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Calhoun | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Cass | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Charlevoix | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Clinton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Crawford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Dickinson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Eaton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Emmet | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Gogebic | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Grand Traverse | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Gratiot | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Hillsdale | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Ingham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Ionia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Iron | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Kalamazoo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Kent | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Lapeer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Lenawee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Livingston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Manistee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Marquette | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Mason | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Mecosta | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Menominee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Midland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Missaukee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Montcalm | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Montmorency | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Muskegon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Newaygo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Oceana | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Osceola | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Otsego | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Ottawa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Schoolcraft | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Shiawassee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
St. Clair | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Van Buren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Washtenaw | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MI - H0540-001-0 Benefit Details
|
Wexford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Becker | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Beltrami | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Big Stone | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Blue Earth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Brown | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Carlton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Carver | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Chippewa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Clay | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Clearwater | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Cook | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Cottonwood | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Crow Wing | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Dakota | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Dodge | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Fillmore | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Freeborn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Goodhue | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Houston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Hubbard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Isanti | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Kandiyohi | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Kittson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Lac qui Parle | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Lake of the Woods | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Lincoln | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Lyon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Mahnomen | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Martin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Morrison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Mower | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Murray | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Nobles | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Norman | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Olmsted | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Otter Tail | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Pennington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Pine | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Pipestone | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Ramsey | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Red Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Redwood | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Rice | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Rock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
St. Louis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Stearns | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Steele | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Swift | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Todd | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Traverse | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Wabasha | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Waseca | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Watonwan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Wilkin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Winona | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-001-0 Benefit Details
|
Yellow Medicine | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Adams | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Antelope | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Arthur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Banner | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Blaine | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Boone | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Box Butte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Boyd | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Brown | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Buffalo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Butler | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Cass | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Cedar | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Chase | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Cherry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Cheyenne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Clay | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Colfax | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Cuming | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Custer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Dakota | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Dawes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Dawson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Deuel | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Dixon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Dodge | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Dundy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Fillmore | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Frontier | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Furnas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Gage | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Garden | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Garfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Gosper | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Greeley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Hall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Hamilton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Harlan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Hayes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Hitchcock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Holt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Hooker | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Howard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Kearney | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Keith | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Keya Paha | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Kimball | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Knox | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Lancaster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Logan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Loup | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
McPherson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Merrick | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Morrill | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Nance | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Nemaha | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Nuckolls | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Otoe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Pawnee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Perkins | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Phelps | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Pierce | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Platte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Red Willow | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Richardson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Rock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Saline | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Sarpy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Saunders | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Scotts Bluff | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Seward | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Sheridan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Sherman | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Sioux | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Stanton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Thayer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Thomas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Valley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Webster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
Wheeler | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NE - H0540-001-0 Benefit Details
|
York | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NV - H0540-001-0 Benefit Details
|
Churchill | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NV - H0540-001-0 Benefit Details
|
Elko | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NV - H0540-001-0 Benefit Details
|
Esmeralda | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NV - H0540-001-0 Benefit Details
|
Eureka | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NV - H0540-001-0 Benefit Details
|
Humboldt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NV - H0540-001-0 Benefit Details
|
Lander | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NV - H0540-001-0 Benefit Details
|
Washoe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Alamance | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Alexander | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Alleghany | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Anson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Ashe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Avery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Beaufort | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Bertie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Bladen | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Brunswick | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Buncombe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Burke | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Cabarrus | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Caldwell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Camden | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Carteret | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Caswell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Catawba | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Chatham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Cherokee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Chowan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Clay | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Cleveland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Craven | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Cumberland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Currituck | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Dare | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Davie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Durham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Forsyth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Gaston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Gates | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Graham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Granville | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Guilford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Halifax | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Haywood | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Henderson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Hertford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Hoke | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Hyde | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Johnston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Jones | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Lincoln | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Macon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
McDowell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Mecklenburg | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Mitchell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Moore | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
New Hanover | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Northampton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Onslow | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Pamlico | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Pasquotank | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Pender | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Perquimans | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Person | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Pitt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Randolph | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Richmond | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Rockingham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Rowan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Rutherford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Sampson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Scotland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Stanly | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Stokes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Surry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Swain | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Transylvania | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Tyrrell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Union | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Vance | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Wake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Warren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Watauga | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Wilkes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Wilson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Yadkin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NC - H0540-001-0 Benefit Details
|
Yancey | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Abbeville | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Aiken | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Allendale | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Anderson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Berkeley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Calhoun | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Charleston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Cherokee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Clarendon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Colleton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Dorchester | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Edgefield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Fairfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Greenville | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Greenwood | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Kershaw | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Laurens | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Lexington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Marion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
McCormick | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Newberry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Oconee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Orangeburg | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Pickens | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Richland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Saluda | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Spartanburg | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Sumter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
Union | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SC - H0540-001-0 Benefit Details
|
York | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Anderson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Bedford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Benton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Bledsoe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Blount | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Bradley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Campbell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Cannon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Carroll | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Carter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Cheatham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Chester | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Cocke | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Crockett | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Cumberland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Davidson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Decatur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
DeKalb | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Dickson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Dyer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Gibson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Grainger | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Greene | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Grundy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Hamilton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Hardin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Hawkins | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Henderson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Henry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Hickman | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Houston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Humphreys | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Knox | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Lewis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Lincoln | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Loudon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Madison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Marion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Maury | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
McMinn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
McNairy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Meigs | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Monroe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Moore | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Morgan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Overton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Perry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Pickett | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Putnam | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Rhea | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Roane | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Rutherford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Sequatchie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Sevier | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Shelby | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Smith | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Stewart | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Sullivan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Tipton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Unicoi | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Union | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Warren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
White | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Williamson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TN - H0540-001-0 Benefit Details
|
Wilson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Anderson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Angelina | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Aransas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Armstrong | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Atascosa | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Austin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Bee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Bexar | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Borden | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Bowie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Brazoria | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Brewster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Brooks | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Brown | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Burleson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Calhoun | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Callahan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Camp | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Carson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Cass | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Chambers | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Childress | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Clay | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Coke | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Coleman | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Collin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Collingsworth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Comanche | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Concho | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Crane | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Crockett | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Culberson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Dallas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Deaf Smith | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Delta | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Denton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Dimmit | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Duval | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Eastland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Edwards | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
El Paso | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Ellis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Erath | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Fort Bend | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Frio | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Galveston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Garza | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Gillespie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Glasscock | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Gray | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Gregg | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Grimes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Guadalupe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hansford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hardin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Harris | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Harrison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hartley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Haskell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hays | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hemphill | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hill | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hockley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hood | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hopkins | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Houston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Howard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hudspeth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Hunt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Irion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Jack | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Jasper | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Jeff Davis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Jim Hogg | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Jim Wells | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Johnson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Jones | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Kaufman | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Kendall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Kenedy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Kent | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Kinney | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Kleberg | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Knox | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
La Salle | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Lamar | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Lee | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Leon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Liberty | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Limestone | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Lipscomb | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Live Oak | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Loving | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Lynn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Marion | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Martin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Mason | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Maverick | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
McCulloch | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
McLennan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
McMullen | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Medina | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Menard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Midland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Montague | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Montgomery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Morris | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Navarro | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Newton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Nolan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Nueces | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Ochiltree | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Oldham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Orange | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Panola | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Parker | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Parmer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Polk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Presidio | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Rains | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Randall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Reagan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Red River | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Reeves | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Roberts | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Rockwall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Runnels | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Rusk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
San Augustine | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
San Jacinto | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
San Patricio | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
San Saba | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Shackelford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Smith | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Sterling | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Tarrant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Taylor | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Terrell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Throckmorton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Titus | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Tom Green | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Trinity | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Tyler | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Upshur | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Upton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Uvalde | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Val Verde | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Van Zandt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Walker | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Webb | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Wheeler | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Wilbarger | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Wilson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Winkler | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Wise | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Wood | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Yoakum | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Zapata | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in TX - H0540-001-0 Benefit Details
|
Zavala | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Beaver | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Box Elder | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Cache | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Daggett | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Davis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Duchesne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Emery | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Garfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Grand | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Iron | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Juab | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Kane | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Millard | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Morgan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Piute | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Rich | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Salt Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
San Juan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Sanpete | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Sevier | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Summit | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Tooele | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Uintah | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Utah | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Wasatch | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Wayne | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in UT - H0540-001-0 Benefit Details
|
Weber | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Alexandria City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Amelia | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Amherst | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Appomattox | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Arlington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Bedford | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Bedford City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Botetourt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Bristol City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Buena Vista City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Campbell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Carroll | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Charlotte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Chesapeake City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Chesterfield | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Clarke | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Colonial Heights City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Craig | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Culpeper | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Cumberland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Dinwiddie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Emporia City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Fairfax | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Fairfax City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Falls Church City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Floyd | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Galax City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Giles | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Gloucester | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Goochland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Grayson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Greensville | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Halifax | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Hampton City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Hanover | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Harrisonburg City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Henry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Highland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Isle of Wight | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
James City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
King and Queen | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
King William | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Lancaster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Lexington City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Lunenburg | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Lynchburg City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Manassas Park City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Martinsville City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Mathews | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Mecklenburg | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Middlesex | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
New Kent | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Newport News City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Norfolk City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Northampton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Nottoway | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Patrick | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Pittsylvania | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Poquoson City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Portsmouth City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Powhatan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Prince Edward | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Prince William | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Roanoke | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Roanoke City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Rockbridge | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Rockingham | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Salem City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Scott | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Shenandoah | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Smyth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Surry | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Sussex | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Virginia Beach City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Warren | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Williamsburg City | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
Wythe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VA - H0540-001-0 Benefit Details
|
York | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Asotin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Benton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Chelan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Clallam | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Clark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Cowlitz | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Franklin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Grays Harbor | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Island | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Jefferson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
King | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Kitsap | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Kittitas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Klickitat | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Lewis | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Mason | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Okanogan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Pierce | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
San Juan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Skagit | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Skamania | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Snohomish | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Spokane | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Stevens | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Thurston | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Wahkiakum | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Walla Walla | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Whatcom | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Whitman | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WA - H0540-001-0 Benefit Details
|
Yakima | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
Chart Legend:
Below are a few notes to help with the understanding of the 2010 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.
Below are a few notes to help with the understanding of the 2010 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.
|
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