REBIF 44MCG/0.5ML SYRINGE (NDC: 44087004403)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,680.18 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,722.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,709.11 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,832.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,719.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,669.21 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,669.21 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,669.21 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,669.21 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,669.21 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,669.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,669.21 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,669.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,696.60 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,846.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,733.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,733.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,733.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,733.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,733.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,733.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,733.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,733.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,854.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,772.90 |
Browse Plan Formulary |
Humana Gold Plus H4461-015 (HMO)
|
$24.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,713.07 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$26.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,684.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,726.14 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,715.27 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | $2,717.02 |
Browse Plan Formulary |
Humana Gold Plus H4461-001 (HMO)
|
$31.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,675.90 |
Browse Plan Formulary |
Humana Gold Plus H4461-012 (HMO)
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,688.14 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Diamond (PPO)
|
$36.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Ruby (PPO)
|
$37.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,929.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,820.18 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,836.45 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:8 /35Days | $2,793.69 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,724.46 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /30Days | $2,677.53 |
Browse Plan Formulary |