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 AL - H0540-088-0 Benefit Details 
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Autauga | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Baldwin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Barbour | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Bibb | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Blount | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Bullock | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Chambers | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Cherokee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Choctaw | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Clarke | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Coffee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Colbert | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Conecuh | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Coosa | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Dale | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Dallas | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Elmore | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Fayette | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Franklin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Geneva | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Henry | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Houston | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Lamar | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Lauderdale | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Lee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Limestone | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Lowndes | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Macon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Madison | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Marengo | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Marion | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Mobile | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Montgomery | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Perry | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Randolph | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Russell | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Shelby | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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St. Clair | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Sumter | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AL - H0540-088-0 Benefit Details
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Wilcox | $55.00 | 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 AL - H0540-088-0 Benefit Details
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Winston | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AK - H0540-088-0 Benefit Details
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Kodiak Island | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in AK - H0540-088-0 Benefit Details
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Nome | $55.00 | 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 AK - H0540-088-0 Benefit Details
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Yukon-Koyukuk | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in CT - H0540-088-0 Benefit Details
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Middlesex | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in DE - H0540-088-0 Benefit Details
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New Castle | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Baker | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Calhoun | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Columbia | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Escambia | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Flagler | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Franklin | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Gadsden | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Jackson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Jefferson | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Lake | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Lee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Leon | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Madison | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Marion | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Orange | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Osceola | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Polk | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Santa Rosa | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Sarasota | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Seminole | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Suwannee | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Taylor | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Union | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Volusia | $55.00 | 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 FL - H0540-088-0 Benefit Details
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Wakulla | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in FL - H0540-088-0 Benefit Details
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Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in HI - H0540-088-0 Benefit Details
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Hawaii | $55.00 | 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 HI - H0540-088-0 Benefit Details
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Honolulu | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in HI - H0540-088-0 Benefit Details
|
Kalawao | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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SecurityChoice Classic (PFFS) in HI - H0540-088-0 Benefit Details
|
Kauai | $55.00 | 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 HI - H0540-088-0 Benefit Details
|
Maui | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Ada | $55.00 | 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 ID - H0540-088-0 Benefit Details
|
Adams | $55.00 | 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 ID - H0540-088-0 Benefit Details
|
Bannock | $55.00 | 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 ID - H0540-088-0 Benefit Details
|
Bear Lake | $55.00 | 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 ID - H0540-088-0 Benefit Details
|
Bingham | $55.00 | 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 ID - H0540-088-0 Benefit Details
|
Blaine | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Boise | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Bonner | $55.00 | 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 ID - H0540-088-0 Benefit Details
|
Bonneville | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Boundary | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Canyon | $55.00 | 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 ID - H0540-088-0 Benefit Details
|
Caribou | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Cassia | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Clark | $55.00 | 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 ID - H0540-088-0 Benefit Details
|
Custer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Franklin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Fremont | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Gem | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Gooding | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Jerome | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Kootenai | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Latah | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Lemhi | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Lincoln | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Madison | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Minidoka | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Owyhee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Payette | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Power | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Twin Falls | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ID - H0540-088-0 Benefit Details
|
Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Cowley | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Dickinson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Franklin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Harvey | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Kearny | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Morris | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Ottawa | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Saline | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Sedgwick | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in KS - H0540-088-0 Benefit Details
|
Smith | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MD - H0540-088-0 Benefit Details
|
Anne Arundel | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MD - H0540-088-0 Benefit Details
|
Calvert | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MD - H0540-088-0 Benefit Details
|
Charles | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MD - H0540-088-0 Benefit Details
|
Garrett | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MD - H0540-088-0 Benefit Details
|
Harford | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MD - H0540-088-0 Benefit Details
|
Howard | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MD - H0540-088-0 Benefit Details
|
Prince George's | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MD - H0540-088-0 Benefit Details
|
Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan 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 - H0540-088-0 Benefit Details
|
Aitkin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Benton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Cass | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan 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 - H0540-088-0 Benefit Details
|
Faribault | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Itasca | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Kanabec | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan 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 - H0540-088-0 Benefit Details
|
Koochiching | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Le Sueur | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Marshall | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan 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 - H0540-088-0 Benefit Details
|
McLeod | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Meeker | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Nicollet | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan 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 - H0540-088-0 Benefit Details
|
Pope | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Renville | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Roseau | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan 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 - H0540-088-0 Benefit Details
|
Scott | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Sherburne | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Sibley | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan 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 - H0540-088-0 Benefit Details
|
Wadena | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MN - H0540-088-0 Benefit Details
|
Wright | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Attala | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Benton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Calhoun | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Chickasaw | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Choctaw | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Claiborne | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Clay | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Copiah | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
DeSoto | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Franklin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
George | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Grenada | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Hancock | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Hinds | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Holmes | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Issaquena | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Jackson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Lafayette | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Lawrence | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Leake | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Leflore | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Lincoln | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Lowndes | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Madison | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Marshall | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Monroe | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Montgomery | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Neshoba | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Noxubee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Oktibbeha | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Panola | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Pearl River | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Perry | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Pike | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Pontotoc | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Prentiss | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Quitman | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Rankin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Scott | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Stone | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Tate | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Tippah | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Tunica | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Union | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Wilkinson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Winston | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Yalobusha | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MS - H0540-088-0 Benefit Details
|
Yazoo | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Beaverhead | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Blaine | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Broadwater | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Carbon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Carter | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Cascade | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Chouteau | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Custer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Daniels | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Dawson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Deer Lodge | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Fallon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Fergus | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Flathead | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Gallatin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Garfield | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Golden Valley | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Granite | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Hill | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Judith Basin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Lake | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Lewis and Clark | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Liberty | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Lincoln | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Madison | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
McCone | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Meagher | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Missoula | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Petroleum | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Phillips | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Pondera | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Powder River | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Powell | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Prairie | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Ravalli | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Richland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Roosevelt | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Rosebud | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Sanders | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Sheridan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Silver Bow | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Stillwater | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Sweet Grass | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Teton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Toole | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Treasure | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Wheatland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Wibaux | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in MT - H0540-088-0 Benefit Details
|
Yellowstone | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NH - H0540-088-0 Benefit Details
|
Carroll | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NH - H0540-088-0 Benefit Details
|
Grafton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NJ - H0540-088-0 Benefit Details
|
Burlington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NJ - H0540-088-0 Benefit Details
|
Camden | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NJ - H0540-088-0 Benefit Details
|
Cumberland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NJ - H0540-088-0 Benefit Details
|
Gloucester | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NJ - H0540-088-0 Benefit Details
|
Hunterdon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Bernalillo | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Catron | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Chaves | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Cibola | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Colfax | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
DeBaca | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Dona Ana | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Eddy | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Grant | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Guadalupe | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Harding | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Hidalgo | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Lincoln | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Los Alamos | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Luna | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
McKinley | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Mora | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Otero | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Quay | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Rio Arriba | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Roosevelt | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
San Juan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
San Miguel | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Sandoval | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Santa Fe | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Sierra | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Socorro | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Taos | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Torrance | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Union | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NM - H0540-088-0 Benefit Details
|
Valencia | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Allegany | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Broome | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Cattaraugus | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Cayuga | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Chautauqua | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Chemung | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Chenango | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Cortland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Erie | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Franklin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Genesee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Hamilton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Herkimer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Lewis | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Livingston | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Madison | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Niagara | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Oneida | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Onondaga | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Ontario | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Orleans | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Oswego | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Schuyler | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Seneca | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
St. Lawrence | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Steuben | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Tioga | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Tompkins | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Wayne | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Wyoming | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in NY - H0540-088-0 Benefit Details
|
Yates | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Adams | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Barnes | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Billings | $55.00 | 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 ND - H0540-088-0 Benefit Details
|
Bottineau | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Burke | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Burleigh | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Cass | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Cavalier | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Dickey | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Divide | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Dunn | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Eddy | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Emmons | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Foster | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Golden Valley | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Grand Forks | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Grant | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Griggs | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Hettinger | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Kidder | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
LaMoure | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Logan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
McHenry | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
McKenzie | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
McLean | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Mercer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Morton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Mountrail | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Oliver | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Pembina | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Ramsey | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Ransom | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Renville | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Richland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Rolette | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Sheridan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Sioux | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Slope | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Stark | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Steele | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Stutsman | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Towner | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Traill | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Walsh | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Ward | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Wells | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in ND - H0540-088-0 Benefit Details
|
Williams | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Beaver | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Canadian | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Carter | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Comanche | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Craig | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Creek | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Delaware | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Dewey | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Ellis | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Garvin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Greer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Harper | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Hughes | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Kay | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Kingfisher | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Le Flore | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Lincoln | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Logan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
McClain | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
McCurtain | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Muskogee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Nowata | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Okfuskee | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Oklahoma | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Osage | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Ottawa | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Pontotoc | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Pottawatomie | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Pushmataha | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Rogers | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Seminole | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Sequoyah | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Stephens | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Texas | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Tillman | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Tulsa | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Wagoner | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OK - H0540-088-0 Benefit Details
|
Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Baker | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Benton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Clackamas | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Columbia | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Coos | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Crook | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Curry | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Deschutes | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Douglas | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Gilliam | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Grant | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Harney | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Hood River | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Klamath | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Lake | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Lincoln | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Malheur | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Marion | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Morrow | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Multnomah | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Polk | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Sherman | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Tillamook | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Umatilla | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Union | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Wallowa | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Wasco | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in OR - H0540-088-0 Benefit Details
|
Wheeler | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Adams | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Armstrong | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Beaver | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Bedford | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Berks | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Bradford | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Bucks | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Butler | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Carbon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Centre | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Chester | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Clearfield | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Clinton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Columbia | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Cumberland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Dauphin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Delaware | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Erie | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Franklin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Fulton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Greene | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Huntingdon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Juniata | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Lackawanna | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Lancaster | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Lebanon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Lehigh | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Luzerne | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Lycoming | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
McKean | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Mercer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Mifflin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Montgomery | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Montour | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Northampton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Northumberland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Perry | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Philadelphia | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Pike | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Potter | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Schuylkill | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Snyder | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Sullivan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Susquehanna | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Tioga | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Union | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Warren | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Wayne | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Westmoreland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
Wyoming | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in PA - H0540-088-0 Benefit Details
|
York | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in RI - H0540-088-0 Benefit Details
|
Bristol | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in RI - H0540-088-0 Benefit Details
|
Kent | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in RI - H0540-088-0 Benefit Details
|
Newport | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in RI - H0540-088-0 Benefit Details
|
Providence | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in RI - H0540-088-0 Benefit Details
|
Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Aurora | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Beadle | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Bennett | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Brookings | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Brown | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Brule | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Butte | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Campbell | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Clark | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Clay | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Codington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Corson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Custer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Davison | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Day | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Edmunds | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Fall River | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Faulk | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Grant | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Gregory | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Hamlin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Hand | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Hanson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Harding | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Hughes | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Hutchinson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Hyde | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Jackson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Jerauld | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Jones | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Kingsbury | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Lake | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Lawrence | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Lincoln | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Lyman | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Marshall | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
McCook | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
McPherson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Meade | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Mellette | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Miner | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Minnehaha | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Pennington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Perkins | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Potter | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Roberts | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Sanborn | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Spink | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Stanley | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Sully | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Todd | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Tripp | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Turner | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Union | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Walworth | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in SD - H0540-088-0 Benefit Details
|
Yankton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Addison | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Bennington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Caledonia | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Chittenden | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Essex | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Franklin | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Grand Isle | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Lamoille | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Orange | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Orleans | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Rutland | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Washington | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Windham | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in VT - H0540-088-0 Benefit Details
|
Windsor | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in DC - H0540-088-0 Benefit Details
|
District of Columbia | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Berkeley | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Boone | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Braxton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Cabell | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Calhoun | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Clay | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Doddridge | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Fayette | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Gilmer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Grant | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Greenbrier | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Hampshire | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Hardy | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Harrison | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Jackson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Jefferson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Kanawha | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Lewis | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Lincoln | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Logan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Marion | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Mercer | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Mingo | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Monroe | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Morgan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Nicholas | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Ohio | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Pendleton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Pleasants | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Pocahontas | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Preston | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Putnam | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Randolph | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Ritchie | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Roane | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Tucker | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Tyler | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Upshur | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Wayne | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Webster | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Wetzel | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Wirt | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WV - H0540-088-0 Benefit Details
|
Wood | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Albany | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Big Horn | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Carbon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Crook | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Fremont | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Goshen | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Hot Springs | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Johnson | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Laramie | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Natrona | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Niobrara | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Park | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Sheridan | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Teton | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Uinta | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
SecurityChoice Classic (PFFS) in WY - H0540-088-0 Benefit Details
|
Weston | $55.00 | 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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