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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Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Abbeville | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Aiken | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Allendale | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Anderson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Appling | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Atkinson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Bacon | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Baker | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Baldwin | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Bamberg | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Banks | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Barnwell | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Barrow | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Bartow | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Beaufort | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Ben Hill | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Berkeley | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Berrien | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Bibb | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Bleckley | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Brantley | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Brooks | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Bryan | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Bulloch | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Burke | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Butts | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Calhoun | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Calhoun | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Camden | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Candler | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Carroll | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Catoosa | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Charleston | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Charlton | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Chatham | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Chattahoochee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Chattooga | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Cherokee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Cherokee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Chester | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Chesterfield | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Clarendon | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Clarke | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Clay | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Clayton | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Clinch | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Cobb | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Coffee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Colleton | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Colquitt | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Columbia | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Cook | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Coweta | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Crawford | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Crisp | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Dade | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Darlington | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Dawson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Decatur | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
DeKalb | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Dillon | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Dodge | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Dooly | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Dorchester | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Dougherty | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Douglas | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Early | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Echols | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Edgefield | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Effingham | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Elbert | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Emanuel | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Evans | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Fairfield | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Fannin | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Fayette | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Florence | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Floyd | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Forsyth | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Franklin | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Fulton | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Georgetown | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Gilmer | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Glascock | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Glynn | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Gordon | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Grady | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Greene | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Greenville | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Greenwood | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Gwinnett | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Habersham | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Hall | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Hampton | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Hancock | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Haralson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Harris | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Hart | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Heard | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Henry | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Horry | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Houston | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Irwin | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Jackson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Jasper | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Jasper | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Jeff Davis | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Jefferson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Jenkins | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Johnson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Jones | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Kershaw | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Lamar | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Lancaster | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Lanier | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Laurens | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Laurens | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Lee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Lee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Lexington | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Liberty | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Lincoln | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Long | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Lowndes | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Lumpkin | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Macon | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Madison | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Marion | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Marion | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Marlboro | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
McCormick | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
McDuffie | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
McIntosh | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Meriwether | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Miller | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Mitchell | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Monroe | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Montgomery | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Morgan | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Murray | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Muscogee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Newberry | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Newton | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Oconee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Oconee | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Oglethorpe | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Orangeburg | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Paulding | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Peach | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Pickens | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Pickens | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Pierce | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Pike | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Polk | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Pulaski | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Putnam | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Quitman | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Rabun | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Randolph | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Richland | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Richmond | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Rockdale | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Saluda | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Schley | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Screven | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Seminole | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Spalding | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Spartanburg | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Statewide | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Statewide | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Stephens | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Stewart | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Sumter | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Sumter | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Talbot | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Taliaferro | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Tattnall | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Taylor | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Telfair | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Terrell | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Thomas | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Tift | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Toombs | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Towns | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Treutlen | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Troup | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Turner | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Twiggs | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Union | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Union | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Upson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Walker | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Walton | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Ware | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Warren | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
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 | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Washington | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Wayne | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Webster | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Wheeler | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
White | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Whitfield | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Wilcox | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Wilkes | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Wilkinson | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
Williamsburg | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in GA - R9896-010-0 Benefit Details |
Worth | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
Care Improvement Plus Gold Rx Advantage (Regional PPO) in SC - R9896-010-0 Benefit Details |
York | $14.00 | $0 | No Gap Coverage | Formulary Generic: $4.00 Formulary Preferred Brand: $45.00 Formulary Non-Preferred Brand: $95.00 Formulary Specialty: 33% | n/a Browse Formulary | |||||
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