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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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details 
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Baldwin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Bibb | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Cherokee | $39.00 | 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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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Clarke | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Conecuh | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Covington | $39.00 | 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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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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DeKalb | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Escambia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Etowah | $39.00 | 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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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Jackson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Limestone | $39.00 | 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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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Madison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Marshall | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Mobile | $39.00 | 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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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Monroe | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Morgan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Shelby | $39.00 | 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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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Tuscaloosa | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Walker | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AL - H5006-018-1 Benefit Details
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Washington | $39.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Arkansas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Benton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Boone | $59.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Carroll | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Cleburne | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Conway | $59.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Craighead | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Crawford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Crittenden | $39.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Cross | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Faulkner | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Franklin | $39.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Garland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Grant | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Hot Spring | $59.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Johnson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Lee | $59.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Logan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Lonoke | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Madison | $39.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Marion | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Mississippi | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Newton | $59.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Perry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Poinsett | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Pope | $59.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Prairie | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Pulaski | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Saline | $39.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Scott | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Sebastian | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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St. Francis | $59.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Van Buren | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-1 Benefit Details
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Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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White | $59.00 | 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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Sterling Basic Plus (PFFS) in AR - H5006-018-2 Benefit Details
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Yell | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Alameda | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Alpine | $109.00 | 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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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Amador | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Calaveras | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Colusa | $109.00 | 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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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Contra Costa | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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El Dorado | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Fresno | $109.00 | 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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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Lake | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Madera | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Mendocino | $109.00 | 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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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Napa | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Placer | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Sacramento | $109.00 | 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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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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San Luis Obispo | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
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Santa Barbara | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
|
Solano | $109.00 | 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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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
|
Sonoma | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
|
Tulare | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CA - H5006-018-3 Benefit Details
|
Yolo | $109.00 | 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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Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Adams | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Arapahoe | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-1 Benefit Details
|
Boulder | $39.00 | 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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Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Broomfield | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Clear Creek | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Denver | $109.00 | 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 | |||||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Douglas | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-1 Benefit Details
|
El Paso | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Elbert | $109.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Gilpin | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Jefferson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-1 Benefit Details
|
Larimer | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in CO - H5006-018-3 Benefit Details
|
Park | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-1 Benefit Details
|
Pueblo | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in CO - H5006-018-1 Benefit Details
|
Teller | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in CO - H5006-018-1 Benefit Details
|
Weld | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in DE - H5006-018-3 Benefit Details
|
Kent | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in DE - H5006-018-3 Benefit Details
|
New Castle | $109.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in DE - H5006-018-3 Benefit Details
|
Sussex | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in FL - H5006-018-1 Benefit Details
|
Escambia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in FL - H5006-018-1 Benefit Details
|
Okaloosa | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in FL - H5006-018-1 Benefit Details
|
Santa Rosa | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Bartow | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Bryan | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Bulloch | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Burke | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Catoosa | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Chatham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Chattahoochee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Cherokee | $109.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Clayton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Cobb | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Columbia | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Coweta | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Dade | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Dawson | $109.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
DeKalb | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Douglas | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Effingham | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Evans | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Fayette | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Forsyth | $109.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Fulton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Glascock | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Gordon | $109.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Gwinnett | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Hall | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Harris | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Henry | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Jefferson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Liberty | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Lincoln | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Marion | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
McDuffie | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Muscogee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Newton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Paulding | $109.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Pickens | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Richmond | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Rockdale | $109.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Screven | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Stewart | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Taliaferro | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Walker | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in GA - H5006-018-3 Benefit Details
|
Walton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Warren | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in GA - H5006-018-1 Benefit Details
|
Whitfield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in GA - H5006-018-2 Benefit Details
|
Wilkes | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Ada | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Adams | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Bannock | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Bear Lake | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Benewah | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Bingham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Blaine | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Boise | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Bonner | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Bonneville | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Boundary | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Butte | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Camas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Canyon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Caribou | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Cassia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Clark | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Clearwater | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Custer | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Elmore | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Franklin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Fremont | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Gem | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Gooding | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Idaho | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Jerome | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Kootenai | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Latah | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Lemhi | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Lewis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Madison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Minidoka | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Nez Perce | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Oneida | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Owyhee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Payette | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Power | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Shoshone | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Teton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Twin Falls | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Valley | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ID - H5006-018-1 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Bond | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Boone | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Calhoun | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Champaign | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Clinton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
De Witt | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Ford | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Fulton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Greene | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Henry | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Jersey | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Kankakee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Knox | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Livingston | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Logan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Macoupin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-1 Benefit Details
|
Madison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Marshall | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Mason | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-1 Benefit Details
|
McLean | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Mercer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Monroe | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Montgomery | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Ogle | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-1 Benefit Details
|
Peoria | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Piatt | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Randolph | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Rock Island | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-1 Benefit Details
|
St. Clair | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Stark | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Stephenson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-1 Benefit Details
|
Tazewell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Vermilion | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Wabash | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Washington | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
White | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Whiteside | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-2 Benefit Details
|
Winnebago | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IL - H5006-018-1 Benefit Details
|
Woodford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Adams | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-2 Benefit Details
|
Allen | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Boone | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-1 Benefit Details
|
Clark | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
De Kalb | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Delaware | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Dubois | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Elkhart | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-1 Benefit Details
|
Floyd | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Fulton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-1 Benefit Details
|
Gibson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Hamilton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Hancock | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-1 Benefit Details
|
Harrison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Hendricks | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Henry | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Huntington | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Johnson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Kosciusko | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
La Porte | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Lagrange | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Madison | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Marion | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Marshall | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Miami | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Morgan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Noble | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Pike | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-1 Benefit Details
|
Posey | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Rush | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Shelby | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Spencer | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-2 Benefit Details
|
St. Joseph | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Starke | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Steuben | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-1 Benefit Details
|
Vanderburgh | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-3 Benefit Details
|
Wabash | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-1 Benefit Details
|
Warrick | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-2 Benefit Details
|
Wells | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IN - H5006-018-2 Benefit Details
|
Whitley | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Adair | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Adams | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Allamakee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Appanoose | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Audubon | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Benton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Black Hawk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Boone | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Bremer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Buchanan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Buena Vista | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Butler | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Calhoun | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Carroll | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Cass | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Cedar | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Cerro Gordo | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Cherokee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Chickasaw | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Clarke | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Clay | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Clayton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Clinton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Crawford | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Dallas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Davis | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Decatur | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Delaware | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Des Moines | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Dickinson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Dubuque | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Emmet | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Fayette | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Floyd | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Franklin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Fremont | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Greene | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Grundy | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Guthrie | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Hamilton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Hancock | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Hardin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Harrison | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Henry | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Howard | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Humboldt | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Ida | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Iowa | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Jackson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Jasper | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Jefferson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Johnson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Jones | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Keokuk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Kossuth | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Lee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Linn | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Louisa | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Lucas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Lyon | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Madison | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Mahaska | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Marion | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Marshall | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Mills | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Mitchell | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Monona | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Monroe | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Montgomery | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Muscatine | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
O'Brien | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Osceola | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Page | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Palo Alto | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Plymouth | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Pocahontas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Polk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Pottawattamie | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Poweshiek | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Ringgold | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Sac | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Scott | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Shelby | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Sioux | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Story | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Tama | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Taylor | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Union | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Van Buren | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Wapello | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Warren | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Washington | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Wayne | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Webster | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Winnebago | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Winneshiek | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Woodbury | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Worth | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in IA - H5006-018-2 Benefit Details
|
Wright | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Atchison | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Butler | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Doniphan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Douglas | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Franklin | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Harvey | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Jackson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Jefferson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Johnson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Leavenworth | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Miami | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Osage | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Sedgwick | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Shawnee | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Sumner | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KS - H5006-018-3 Benefit Details
|
Wyandotte | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Adair | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Allen | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Anderson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Ballard | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Barren | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Bath | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Bell | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Boone | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Bourbon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Boyd | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Boyle | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Bracken | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Breathitt | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Breckinridge | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Bullitt | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Butler | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Caldwell | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Calloway | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Campbell | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Carlisle | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Carroll | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Carter | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Casey | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Christian | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Clark | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Clay | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Clinton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Crittenden | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Cumberland | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Daviess | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Edmonson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Elliott | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Estill | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Fayette | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Fleming | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Floyd | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Franklin | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Fulton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Gallatin | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Garrard | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Grant | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Graves | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Grayson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Green | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Greenup | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Hancock | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Hardin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Harlan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Harrison | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Hart | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Henderson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Henry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Hickman | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Hopkins | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Jackson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Jessamine | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Johnson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Kenton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Knott | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Knox | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Larue | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Laurel | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Lawrence | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Lee | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Leslie | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Letcher | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Lewis | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Lincoln | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Livingston | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Logan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Lyon | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Madison | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Magoffin | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Marion | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Marshall | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Martin | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Mason | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
McCracken | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
McCreary | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
McLean | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Meade | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Menifee | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Mercer | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Metcalfe | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Monroe | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Montgomery | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Morgan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Muhlenberg | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Nelson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Nicholas | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Ohio | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Oldham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Owen | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Owsley | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Pendleton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Perry | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Pike | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Powell | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Pulaski | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Robertson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Rockcastle | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Rowan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Russell | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Scott | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Shelby | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Simpson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Spencer | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Taylor | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Todd | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Trigg | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Trimble | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Union | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Warren | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Washington | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Wayne | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Webster | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Whitley | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-3 Benefit Details
|
Wolfe | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in KY - H5006-018-1 Benefit Details
|
Woodford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Acadia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Allen | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Ascension | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Assumption | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Avoyelles | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Beauregard | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Bienville | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Bossier | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Caddo | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Calcasieu | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Caldwell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Cameron | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Catahoula | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Claiborne | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Concordia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
De Soto | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
East Baton Rouge | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
East Carroll | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
East Feliciana | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Evangeline | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Franklin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Grant | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Iberia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Iberville | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Jackson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Jefferson Davis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
La Salle | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Lafayette | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Livingston | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Madison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Morehouse | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Natchitoches | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Ouachita | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Pointe Coupee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Rapides | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Red River | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Richland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Sabine | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
St. Helena | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
St. Landry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
St. Martin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
St. Mary | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Tangipahoa | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Tensas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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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 | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Union | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Vermilion | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Vernon | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Webster | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
West Baton Rouge | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
West Carroll | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
West Feliciana | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in LA - H5006-018-1 Benefit Details
|
Winn | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in MI - H5006-018-2 Benefit Details
|
Allegan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in MI - H5006-018-2 Benefit Details
|
Barry | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in MI - H5006-018-2 Benefit Details
|
Ionia | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in MI - H5006-018-2 Benefit Details
|
Kent | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in MI - H5006-018-2 Benefit Details
|
Muskegon | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
Sterling Basic Plus (PFFS) in MI - H5006-018-2 Benefit Details
|
Ottawa | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Aitkin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Anoka | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Becker | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Beltrami | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Benton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Big Stone | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Blue Earth | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Brown | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Carlton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Carver | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Cass | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Chippewa | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Chisago | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Clay | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Clearwater | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Cook | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Cottonwood | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Crow Wing | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Dakota | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Dodge | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Douglas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Faribault | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Fillmore | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Freeborn | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Goodhue | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Grant | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Hennepin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Houston | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Hubbard | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Isanti | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Itasca | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Jackson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Kanabec | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Kandiyohi | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Kittson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Koochiching | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Lac qui Parle | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Lake | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Lake of the Woods | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Le Sueur | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Lincoln | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Lyon | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Mahnomen | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Marshall | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Martin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
McLeod | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Meeker | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Mille Lacs | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Morrison | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Mower | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Murray | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Nicollet | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Nobles | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Norman | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Olmsted | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Otter Tail | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Pennington | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Pine | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Pipestone | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Polk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Pope | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Ramsey | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Red Lake | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Redwood | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Renville | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Rice | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Rock | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Roseau | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Scott | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Sherburne | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Sibley | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
St. Louis | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Stearns | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Steele | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Stevens | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Swift | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Todd | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Traverse | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Wabasha | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Wadena | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Waseca | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Watonwan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Wilkin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Winona | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-1 Benefit Details
|
Wright | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MN - H5006-018-2 Benefit Details
|
Yellow Medicine | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Bates | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Boone | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Buchanan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Callaway | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Cass | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Christian | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Clay | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Clinton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Cole | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Crawford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Dallas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Douglas | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Franklin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Gasconade | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Greene | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Henry | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Howard | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Iron | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Jackson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Johnson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Laclede | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Lafayette | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Moniteau | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Montgomery | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Osage | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Pike | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Platte | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Polk | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Randolph | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Ray | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
St. Charles | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
St. Francois | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
St. Louis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
St. Louis City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Ste. Genevieve | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Warren | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-1 Benefit Details
|
Webster | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MO - H5006-018-3 Benefit Details
|
Wright | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Beaverhead | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Big Horn | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Blaine | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Broadwater | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Carbon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Carter | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Cascade | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Chouteau | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Custer | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Daniels | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Dawson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Deer Lodge | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Fallon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Fergus | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Flathead | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Gallatin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Garfield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Glacier | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Golden Valley | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Granite | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Hill | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Judith Basin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Lake | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Lewis and Clark | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Liberty | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Madison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
McCone | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Meagher | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Mineral | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Missoula | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Musselshell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Park | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Petroleum | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Phillips | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Pondera | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Powder River | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Powell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Prairie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Ravalli | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Richland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Roosevelt | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Rosebud | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Sanders | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Sheridan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Silver Bow | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Stillwater | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Sweet Grass | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Teton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Toole | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Treasure | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Valley | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Wheatland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Wibaux | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in MT - H5006-018-1 Benefit Details
|
Yellowstone | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Adams | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Antelope | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Arthur | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Banner | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Blaine | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Boone | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Box Butte | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Boyd | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Brown | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Buffalo | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Burt | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Butler | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Cass | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Cedar | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Chase | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Cherry | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Cheyenne | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Clay | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Colfax | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Cuming | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Custer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Dakota | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Dawes | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Dawson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Deuel | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Dixon | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Dodge | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Douglas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Dundy | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Fillmore | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Franklin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Frontier | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Furnas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Gage | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Garden | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Garfield | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Gosper | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Grant | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Greeley | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Hall | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Hamilton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Harlan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Hayes | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Hitchcock | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Holt | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Hooker | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Howard | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Jefferson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Johnson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Kearney | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Keith | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Keya Paha | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Kimball | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Knox | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Lancaster | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Lincoln | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Logan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Loup | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Madison | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
McPherson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Merrick | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Morrill | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Nance | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Nemaha | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Nuckolls | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Otoe | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Pawnee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Perkins | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Phelps | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Pierce | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Platte | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Polk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Red Willow | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Richardson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Rock | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Saline | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Sarpy | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Saunders | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Scotts Bluff | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Seward | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Sheridan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Sherman | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Sioux | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Stanton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Thayer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Thomas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Thurston | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Valley | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Washington | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Wayne | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Webster | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
Wheeler | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NE - H5006-018-2 Benefit Details
|
York | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NV - H5006-018-1 Benefit Details
|
Carson City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NV - H5006-018-2 Benefit Details
|
Clark | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NV - H5006-018-1 Benefit Details
|
Douglas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NV - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NV - H5006-018-1 Benefit Details
|
Lyon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NV - H5006-018-1 Benefit Details
|
Storey | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NV - H5006-018-1 Benefit Details
|
Washoe | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NJ - H5006-018-2 Benefit Details
|
Atlantic | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NJ - H5006-018-2 Benefit Details
|
Cape May | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NJ - H5006-018-2 Benefit Details
|
Cumberland | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NJ - H5006-018-2 Benefit Details
|
Middlesex | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NJ - H5006-018-2 Benefit Details
|
Monmouth | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NJ - H5006-018-2 Benefit Details
|
Ocean | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NJ - H5006-018-2 Benefit Details
|
Salem | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Bernalillo | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Catron | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Chaves | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Cibola | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Colfax | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Curry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
DeBaca | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Dona Ana | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Eddy | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Grant | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Guadalupe | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Harding | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Hidalgo | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Lea | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Los Alamos | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Luna | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
McKinley | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Mora | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Otero | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Quay | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Rio Arriba | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Roosevelt | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
San Juan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
San Miguel | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Sandoval | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Santa Fe | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Sierra | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Socorro | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Taos | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Torrance | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Union | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NM - H5006-018-1 Benefit Details
|
Valencia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Albany | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Allegany | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Bronx | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Broome | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Cattaraugus | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Cayuga | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Chautauqua | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Chemung | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Chenango | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Clinton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Columbia | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Cortland | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Delaware | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Dutchess | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Erie | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Essex | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Franklin | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Fulton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Genesee | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Greene | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Hamilton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Herkimer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Jefferson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Kings | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Lewis | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Livingston | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Madison | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Monroe | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Montgomery | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Nassau | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
New York | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Niagara | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Oneida | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Onondaga | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Ontario | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Orange | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Orleans | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Oswego | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Otsego | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Putnam | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Queens | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Rensselaer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Richmond | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Rockland | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Saratoga | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Schenectady | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Schoharie | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Schuyler | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Seneca | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
St. Lawrence | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Steuben | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Suffolk | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Sullivan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Tioga | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Tompkins | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Ulster | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Warren | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Washington | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-2 Benefit Details
|
Wayne | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Westchester | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Wyoming | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NY - H5006-018-3 Benefit Details
|
Yates | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Alamance | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Anson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Ashe | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Avery | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Buncombe | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Cabarrus | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Chatham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Cumberland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Davidson | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Davie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Durham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Forsyth | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Franklin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Gaston | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Granville | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Guilford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Harnett | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Henderson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Johnston | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Lincoln | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Mecklenburg | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Orange | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Person | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Polk | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Randolph | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Rockingham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Stanly | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Stokes | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Surry | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Transylvania | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Union | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Wake | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-3 Benefit Details
|
Watauga | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in NC - H5006-018-1 Benefit Details
|
Yadkin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Barnes | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Benson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Cass | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Cavalier | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Dickey | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Eddy | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Foster | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Grand Forks | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Griggs | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
LaMoure | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Nelson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Pembina | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Ramsey | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Ransom | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Richland | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Sargent | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Steele | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Stutsman | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Towner | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Traill | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in ND - H5006-018-2 Benefit Details
|
Walsh | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Defiance | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Erie | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Fulton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Henry | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Ottawa | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Paulding | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Putnam | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Sandusky | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Van Wert | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Williams | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OH - H5006-018-3 Benefit Details
|
Wood | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Adair | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Atoka | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Blaine | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Caddo | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Canadian | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Cherokee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Choctaw | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Cleveland | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Comanche | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Craig | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Creek | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Custer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Delaware | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Garvin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Grady | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Haskell | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Hughes | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Kingfisher | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Kiowa | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Latimer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Le Flore | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Logan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Mayes | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
McClain | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
McCurtain | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
McIntosh | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Murray | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Muskogee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Noble | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Nowata | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Okfuskee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Oklahoma | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Okmulgee | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Ottawa | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Pawnee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Payne | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Pittsburg | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Pottawatomie | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Pushmataha | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Rogers | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Seminole | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Sequoyah | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Tulsa | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-1 Benefit Details
|
Wagoner | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Washington | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OK - H5006-018-2 Benefit Details
|
Washita | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Benton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-1 Benefit Details
|
Clackamas | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Clatsop | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-1 Benefit Details
|
Columbia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Coos | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Curry | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Deschutes | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Douglas | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Hood River | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Jackson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Josephine | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Klamath | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Lake | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-1 Benefit Details
|
Lane | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Lincoln | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Linn | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Marion | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Morrow | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-1 Benefit Details
|
Multnomah | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Polk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Tillamook | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Umatilla | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Union | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-2 Benefit Details
|
Wallowa | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-1 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in OR - H5006-018-1 Benefit Details
|
Yamhill | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Adams | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Allegheny | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Armstrong | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Beaver | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Bedford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Berks | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Blair | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Bradford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Bucks | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Butler | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Cambria | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Cameron | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Carbon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Centre | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Chester | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Clarion | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Clearfield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Clinton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Columbia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Crawford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Cumberland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Dauphin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Delaware | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Elk | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Erie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Fayette | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Forest | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Franklin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Fulton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Greene | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Huntingdon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Indiana | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Juniata | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Lackawanna | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Lancaster | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Lawrence | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Lebanon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Lehigh | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Luzerne | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Lycoming | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
McKean | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Mercer | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Mifflin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Monroe | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Montgomery | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Montour | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Northampton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Northumberland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Perry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Philadelphia | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Pike | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Potter | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Schuylkill | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Snyder | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Somerset | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Sullivan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Susquehanna | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Tioga | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Union | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Venango | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Warren | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Washington | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Wayne | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-2 Benefit Details
|
Westmoreland | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
Wyoming | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in PA - H5006-018-1 Benefit Details
|
York | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Aiken | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Anderson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Beaufort | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Berkeley | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Calhoun | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Charleston | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Cherokee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Colleton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Dorchester | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Edgefield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Fairfield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Florence | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Georgetown | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Greenville | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Horry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Jasper | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Kershaw | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Laurens | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Lexington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Marion | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Oconee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Pickens | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Richland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Saluda | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Spartanburg | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Union | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
Williamsburg | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SC - H5006-018-1 Benefit Details
|
York | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Aurora | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Beadle | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Bennett | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Bon Homme | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Brookings | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Brown | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Brule | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Buffalo | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Butte | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Campbell | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Charles Mix | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Clark | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Clay | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Codington | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Corson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Custer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Davison | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Day | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Deuel | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Dewey | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Douglas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Edmunds | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Fall River | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Faulk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Grant | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Gregory | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Haakon | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Hamlin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Hand | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Hanson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Harding | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Hughes | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Hutchinson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Hyde | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Jackson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Jerauld | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Jones | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Kingsbury | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Lake | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Lawrence | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Lincoln | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Lyman | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Marshall | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
McCook | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
McPherson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Meade | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Mellette | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Miner | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Minnehaha | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Moody | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Pennington | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Perkins | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Potter | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Roberts | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Sanborn | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Shannon | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Spink | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Stanley | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Sully | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Todd | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Tripp | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Turner | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Union | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Walworth | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Washabaugh | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Yankton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in SD - H5006-018-2 Benefit Details
|
Ziebach | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Anderson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Bedford | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Benton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Bledsoe | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Blount | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Bradley | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Campbell | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Cannon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Carroll | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Carter | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Cheatham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Chester | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Claiborne | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Clay | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Cocke | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Coffee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Crockett | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Cumberland | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Decatur | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
DeKalb | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Dickson | $39.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Dyer | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-3 Benefit Details
|
Fayette | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Fentress | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Franklin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Gibson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Giles | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Grainger | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Greene | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Grundy | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Hamblen | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Hamilton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Hancock | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Hardeman | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Hardin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Hawkins | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Haywood | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Henderson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Henry | $59.00 | 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 | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Hickman | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Houston | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Humphreys | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Jackson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Jefferson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Johnson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Knox | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
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|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Lake | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Lauderdale | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Lawrence | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Lewis | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Lincoln | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Loudon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Macon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Madison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Marion | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Marshall | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
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|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Maury | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
McMinn | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
McNairy | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Meigs | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Monroe | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Montgomery | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Moore | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Morgan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Obion | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Overton | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Perry | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Pickett | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Polk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Putnam | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Rhea | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Roane | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Robertson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Scott | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Sequatchie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Sevier | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-3 Benefit Details
|
Shelby | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Smith | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Stewart | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Sullivan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Sumner | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-3 Benefit Details
|
Tipton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Trousdale | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Unicoi | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Union | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Van Buren | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Warren | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Wayne | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
Weakley | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-2 Benefit Details
|
White | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TN - H5006-018-1 Benefit Details
|
Wilson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Anderson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Andrews | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Angelina | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Aransas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Atascosa | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Austin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Bandera | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Bastrop | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Bee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Bell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Bexar | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Blanco | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Bosque | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Brown | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Burnet | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Caldwell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Calhoun | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Callahan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Camp | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Cass | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Cherokee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Coke | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Coleman | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Collin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Colorado | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Comal | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Comanche | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Concho | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Cooke | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Coryell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Crane | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Dallas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Delta | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Denton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
DeWitt | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Eastland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Ector | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
El Paso | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Ellis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Erath | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Falls | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Fannin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Fayette | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Fisher | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Franklin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Freestone | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Gillespie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Glasscock | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Goliad | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Gonzales | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Grayson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Gregg | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Guadalupe | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Hamilton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Harrison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Hays | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Henderson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Hill | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Hood | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Hopkins | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Houston | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Howard | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Hudspeth | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Hunt | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Jack | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Jackson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Jasper | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Jim Wells | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Johnson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Jones | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Karnes | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Kaufman | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Kendall | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Kimble | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Kleberg | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Lamar | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Lampasas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Lavaca | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Lee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Leon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Limestone | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Live Oak | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Llano | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Madison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Marion | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Martin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Mason | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Matagorda | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
McCulloch | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
McLennan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Medina | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Menard | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Midland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Mills | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Mitchell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Montague | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Morris | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Nacogdoches | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Navarro | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Newton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Nolan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Nueces | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Palo Pinto | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Panola | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Parker | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Polk | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Rains | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Reagan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Red River | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Refugio | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Robertson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Rockwall | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Runnels | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Rusk | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Sabine | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
San Augustine | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
San Patricio | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
San Saba | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Schleicher | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Scurry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Shackelford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Shelby | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Smith | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Somervell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Stephens | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Sterling | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Sutton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Tarrant | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Taylor | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Titus | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Tom Green | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Travis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Trinity | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Tyler | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Upshur | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Upton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Van Zandt | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Victoria | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Walker | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Wharton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Williamson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Wilson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Winkler | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Wise | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in TX - H5006-018-1 Benefit Details
|
Wood | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Beaver | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Box Elder | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Cache | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Carbon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Davis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Garfield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Iron | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Juab | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Kane | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Morgan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Piute | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Rich | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Salt Lake | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Sanpete | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Summit | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Tooele | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Utah | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Wasatch | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in UT - H5006-018-1 Benefit Details
|
Weber | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Amelia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Caroline | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Charles City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Chesterfield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Colonial Heights City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Dinwiddie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Goochland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Hanover | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Henrico | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Hopewell City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
King William | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Louisa | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
New Kent | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Petersburg City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Powhatan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Prince George | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in VA - H5006-018-1 Benefit Details
|
Richmond City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Adams | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Asotin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-3 Benefit Details
|
Benton | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-2 Benefit Details
|
Chelan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Clallam | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Clark | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Columbia | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Cowlitz | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-2 Benefit Details
|
Douglas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Ferry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-3 Benefit Details
|
Franklin | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Garfield | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-2 Benefit Details
|
Grant | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Grays Harbor | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Island | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
King | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Kitsap | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-2 Benefit Details
|
Kittitas | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-3 Benefit Details
|
Klickitat | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Lewis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Mason | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-3 Benefit Details
|
Okanogan | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Pacific | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Pend Oreille | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Pierce | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
San Juan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Skagit | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Skamania | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Snohomish | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Spokane | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Stevens | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Thurston | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Wahkiakum | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Walla Walla | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Whatcom | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-1 Benefit Details
|
Whitman | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WA - H5006-018-3 Benefit Details
|
Yakima | $109.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WV - H5006-018-1 Benefit Details
|
Boone | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WV - H5006-018-1 Benefit Details
|
Clay | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WV - H5006-018-1 Benefit Details
|
Fayette | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WV - H5006-018-1 Benefit Details
|
Kanawha | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WV - H5006-018-1 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WV - H5006-018-1 Benefit Details
|
Putnam | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Barron | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Brown | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Buffalo | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Burnett | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Calumet | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Columbia | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Dane | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Dodge | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Door | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Dunn | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Fond du Lac | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Green | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Iowa | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Jefferson | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Kewaunee | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Lafayette | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Manitowoc | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Marinette | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Oconto | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Outagamie | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Pepin | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Pierce | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Polk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Rock | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Sauk | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Shawano | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Sheboygan | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
St. Croix | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Washburn | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Waupaca | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WI - H5006-018-2 Benefit Details
|
Winnebago | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Albany | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Big Horn | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Campbell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Crook | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Hot Springs | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Johnson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Laramie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Park | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Sheridan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Washakie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
|
|
|
|||||||||
|
Sterling Basic Plus (PFFS) in WY - H5006-018-1 Benefit Details
|
Weston | $39.00 | 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.
|
Q1 Quick Links
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