2011 Medicare Part D Contract ID/Plan ID Search
This is archive material for research purposes. Please see
PDPFinder.com or
MAFinder.com for current plans.
Enter a Contract ID and Plan ID
| 2011 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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| Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
| Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details 
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Ashley | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Bradley | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Calhoun | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Chicot | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Cleveland | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Columbia | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Dallas | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Desha | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Drew | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Hempstead | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Howard | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Izard | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Lafayette | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Lawrence | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Lee | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Lincoln | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Little River | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Nevada | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Phillips | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Sevier | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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St. Francis | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Union | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in AR - H5006-014-1 Benefit Details
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Van Buren | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Bay | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Dixie | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Gilchrist | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Gulf | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Hamilton | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Hardee | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Hendry | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Highlands | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Holmes | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Jackson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Lafayette | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Levy | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Monroe | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Taylor | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Walton | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in FL - H5006-014-5 Benefit Details
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Washington | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Appling | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Atkinson | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Bacon | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Baker | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Baldwin | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Banks | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Barrow | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Bartow | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Ben Hill | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Berrien | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Bibb | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Bleckley | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Brooks | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Bulloch | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Burke | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Butts | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Calhoun | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Camden | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Candler | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Carroll | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Catoosa | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Charlton | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Chattahoochee | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Chattooga | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Clay | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Clinch | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Coffee | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Colquitt | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Cook | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Crisp | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Dade | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Dawson | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Decatur | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
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Dodge | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
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Dooly | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Dougherty | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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| Service | Exper. | Cost Info | |||||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Early | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Echols | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Elbert | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Emanuel | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Evans | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Fannin | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Franklin | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Gilmer | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Glascock | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Gordon | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Grady | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Greene | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Habersham | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Hancock | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Haralson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Hart | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Heard | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Houston | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Irwin | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Jackson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Jasper | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Jeff Davis | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Jefferson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Jenkins | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Johnson | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Jones | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Lamar | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Lanier | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Laurens | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Lee | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Lincoln | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Long | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Lowndes | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Lumpkin | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Macon | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Marion | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
McDuffie | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Meriwether | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Miller | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Mitchell | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Montgomery | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Morgan | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Newton | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Peach | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Pickens | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Pierce | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Pike | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Polk | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Pulaski | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Putnam | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Quitman | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Rabun | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Randolph | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Schley | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Screven | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Seminole | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Spalding | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Stephens | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Stewart | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Sumter | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Taliaferro | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Tattnall | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Taylor | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Telfair | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Terrell | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Thomas | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Tift | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Toombs | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Towns | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Treutlen | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Troup | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Turner | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Twiggs | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Union | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Upson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Walker | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Walton | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Ware | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Warren | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Washington | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Wayne | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Webster | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Wheeler | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
White | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Wilcox | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Wilkes | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-5 Benefit Details
|
Wilkinson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in GA - H5006-014-2 Benefit Details
|
Worth | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Adams | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Bear Lake | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Blaine | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Butte | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Camas | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Clearwater | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Custer | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Franklin | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Idaho | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Jerome | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Lemhi | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Lewis | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Lincoln | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ID - H5006-014-5 Benefit Details
|
Valley | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Bond | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Clay | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Clinton | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Fayette | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Hardin | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Kankakee | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Macon | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Marion | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Massac | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Perry | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Pope | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Pulaski | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Shelby | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IL - H5006-014-2 Benefit Details
|
Washington | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Adair | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Adams | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Audubon | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Buena Vista | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Calhoun | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Carroll | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Cerro Gordo | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Cherokee | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Clay | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Decatur | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Dickinson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Emmet | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Franklin | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Hancock | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Howard | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Humboldt | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Ida | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Kossuth | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Lyon | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Mitchell | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
O'Brien | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Osceola | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Palo Alto | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Pocahontas | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Ringgold | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Sac | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Sioux | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Taylor | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Union | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Webster | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Winnebago | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in IA - H5006-014-5 Benefit Details
|
Worth | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Allen | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Anderson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Atchison | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Barber | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Barton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Bourbon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Brown | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Chase | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Chautauqua | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Cherokee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Cheyenne | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Clark | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Clay | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Cloud | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Coffey | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Comanche | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Cowley | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Crawford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Decatur | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Dickinson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Doniphan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Edwards | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Elk | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Ellis | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Ellsworth | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Finney | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Ford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Franklin | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Geary | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Gove | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Graham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Grant | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Gray | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Greeley | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Greenwood | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Hamilton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Harper | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Haskell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Hodgeman | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Jackson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Jefferson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Jewell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Kearny | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Kingman | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Kiowa | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Labette | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Lane | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Lincoln | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Logan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Lyon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Marion | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Marshall | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
McPherson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Meade | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Mitchell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Montgomery | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Morris | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Morton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Nemaha | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Neosho | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Ness | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Norton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Osage | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Osborne | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Ottawa | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Pawnee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Phillips | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Pottawatomie | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Pratt | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Rawlins | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Reno | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Republic | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Rice | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Riley | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Rooks | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Rush | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Russell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Saline | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Scott | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Seward | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Sheridan | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Sherman | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Smith | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Stafford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Stanton | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Stevens | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Sumner | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Thomas | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Trego | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Wabaunsee | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Wallace | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Washington | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Wichita | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Wilson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KS - H5006-014-3 Benefit Details
|
Woodson | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Adair | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Allen | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Ballard | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Barren | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Bath | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Bell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Bourbon | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Boyd | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Boyle | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Bracken | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Breathitt | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Breckinridge | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Butler | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Caldwell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Calloway | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Carlisle | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Carroll | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Carter | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Casey | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Christian | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Clay | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Clinton | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Crittenden | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Cumberland | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Daviess | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Edmonson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Elliott | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Estill | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Fleming | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Floyd | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Franklin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Fulton | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Gallatin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Garrard | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Grant | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Graves | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Grayson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Green | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Greenup | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Hancock | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Hardin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Harlan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Harrison | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Hart | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Henderson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Henry | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Hickman | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Hopkins | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Jackson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Johnson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Knott | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Knox | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Larue | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Laurel | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Lawrence | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Lee | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Leslie | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Letcher | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Lewis | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Lincoln | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Livingston | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Logan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Lyon | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Magoffin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Marion | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Marshall | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Martin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Mason | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
McCreary | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
McLean | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Meade | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Menifee | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Mercer | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Metcalfe | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Monroe | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Montgomery | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Morgan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Muhlenberg | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Nelson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Nicholas | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Ohio | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Owen | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Owsley | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Pendleton | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Perry | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Pike | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Powell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Pulaski | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Robertson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Rockcastle | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Rowan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Russell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Scott | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Simpson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Taylor | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Todd | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Trigg | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Trimble | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Union | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Washington | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Wayne | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Webster | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Whitley | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in KY - H5006-014-1 Benefit Details
|
Wolfe | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Allen | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Assumption | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Avoyelles | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Beauregard | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Calcasieu | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Cameron | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Evangeline | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Iberia | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Lafourche | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Sabine | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
St. Helena | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
St. Mary | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Terrebonne | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Vermilion | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in LA - H5006-014-1 Benefit Details
|
Vernon | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Alcorn | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Amite | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Bolivar | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Calhoun | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Chickasaw | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Choctaw | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Clay | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Franklin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Greene | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Grenada | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Holmes | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Humphreys | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Issaquena | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Itawamba | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Jasper | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Jefferson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Jefferson Davis | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Lee | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Leflore | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Monroe | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Montgomery | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Neshoba | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Noxubee | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Oktibbeha | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Perry | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Pontotoc | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Quitman | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Sharkey | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Tallahatchie | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Tishomingo | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Wayne | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Webster | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
Sterling Option I (PFFS) in MS - H5006-014-1 Benefit Details
|
Wilkinson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Adair | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Andrew | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Atchison | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Audrain | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Bates | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Benton | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Bollinger | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Buchanan | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Butler | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Caldwell | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Camden | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Cape Girardeau | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Carroll | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Carter | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Chariton | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Clark | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Clinton | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Cooper | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Daviess | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
DeKalb | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Dent | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Dunklin | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Gentry | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Grundy | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Harrison | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Holt | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Howard | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Howell | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Iron | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Knox | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Lewis | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Linn | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Livingston | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Macon | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Madison | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Maries | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Marion | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Mercer | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Mississippi | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Monroe | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Morgan | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
New Madrid | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Nodaway | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Oregon | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Ozark | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Pemiscot | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Perry | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Pettis | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Pike | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Putnam | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Ralls | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Randolph | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Reynolds | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Ripley | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Saline | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Schuyler | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Scotland | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Scott | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Shannon | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Shelby | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
St. Clair | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
St. Francois | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Ste. Genevieve | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Stoddard | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Sullivan | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Texas | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Vernon | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Wayne | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MO - H5006-014-2 Benefit Details
|
Worth | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Blaine | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Carter | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Chouteau | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Custer | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Daniels | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Dawson | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Deer Lodge | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Fallon | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Garfield | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Glacier | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Golden Valley | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Hill | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Judith Basin | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Liberty | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Lincoln | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Madison | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
McCone | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Meagher | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Musselshell | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Petroleum | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Phillips | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Pondera | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Powder River | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Prairie | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Richland | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Roosevelt | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Rosebud | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Sheridan | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Silver Bow | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Teton | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Toole | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Treasure | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Valley | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Wheatland | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in MT - H5006-014-4 Benefit Details
|
Wibaux | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NH - H5006-014-1 Benefit Details
|
Hillsborough | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NH - H5006-014-1 Benefit Details
|
Rockingham | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NH - H5006-014-1 Benefit Details
|
Strafford | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Anson | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Beaufort | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Bladen | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Buncombe | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Burke | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Camden | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Cherokee | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Chowan | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Clay | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Cleveland | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Columbus | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Craven | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Currituck | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Dare | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Duplin | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Franklin | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Graham | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Granville | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Harnett | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Hyde | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Jackson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Jones | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Lenoir | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Lincoln | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Macon | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Madison | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
McDowell | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Mitchell | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Montgomery | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Moore | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Pamlico | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Pasquotank | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Pender | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Polk | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Robeson | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Rutherford | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Sampson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Scotland | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Swain | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Transylvania | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Tyrrell | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Union | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Vance | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Warren | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-4 Benefit Details
|
Washington | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Wilson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in NC - H5006-014-5 Benefit Details
|
Yancey | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Adams | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Benson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Billings | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Bottineau | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Bowman | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Burke | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Burleigh | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Cavalier | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Divide | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Dunn | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Eddy | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Emmons | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Foster | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Golden Valley | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Grant | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Hettinger | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Kidder | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Logan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
McHenry | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
McIntosh | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
McKenzie | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
McLean | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Mercer | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Morton | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Mountrail | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Nelson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Oliver | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Pembina | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Pierce | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Ramsey | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Renville | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Rolette | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Sheridan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Sioux | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Slope | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Stark | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Towner | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Walsh | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Ward | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Wells | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in ND - H5006-014-1 Benefit Details
|
Williams | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Adair | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Alfalfa | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Atoka | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Beaver | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Beckham | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Blaine | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Bryan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Caddo | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Carter | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Cherokee | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Choctaw | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Cimarron | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Coal | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Comanche | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Cotton | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Craig | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Custer | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Dewey | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Ellis | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Garfield | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Garvin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Grant | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Greer | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Harmon | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Harper | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Haskell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Hughes | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Jackson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Jefferson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Johnston | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Kay | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Kingfisher | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Kiowa | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Latimer | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Le Flore | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Love | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Major | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Marshall | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
McCurtain | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
McIntosh | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Murray | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Noble | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Nowata | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Okfuskee | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Ottawa | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Pittsburg | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Pontotoc | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Pushmataha | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Roger Mills | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Stephens | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Texas | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Tillman | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Washita | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Woods | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in OK - H5006-014-1 Benefit Details
|
Woodward | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Aurora | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Beadle | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Bennett | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Bon Homme | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Brule | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Buffalo | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Butte | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Campbell | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Charles Mix | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Clark | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Clay | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Codington | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Corson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Custer | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Davison | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Dewey | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Douglas | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Edmunds | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Fall River | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Faulk | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Gregory | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Haakon | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Hand | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Hanson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Harding | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Hughes | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Hutchinson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Hyde | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Jackson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Jerauld | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Jones | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Kingsbury | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Lake | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Lawrence | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Lyman | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
McCook | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
McPherson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Meade | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Mellette | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Miner | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Pennington | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Perkins | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Potter | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Sanborn | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Shannon | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Spink | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Stanley | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Sully | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Todd | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Tripp | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Turner | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Union | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Walworth | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Washabaugh | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Yankton | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in SD - H5006-014-5 Benefit Details
|
Ziebach | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Benton | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Clay | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Cumberland | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Fentress | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Gibson | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Hardeman | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Haywood | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Henderson | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Henry | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Jackson | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Lincoln | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
McNairy | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Perry | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TN - H5006-014-2 Benefit Details
|
Putnam | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Anderson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Andrews | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Archer | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Bailey | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Bandera | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Baylor | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Bee | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Blanco | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Borden | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Brewster | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Briscoe | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Brooks | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Brown | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Caldwell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Calhoun | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Callahan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Camp | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Castro | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Childress | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Clay | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Cochran | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Collingsworth | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Colorado | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Comanche | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Cooke | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Cottle | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Crane | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Culberson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Dallam | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Dawson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Deaf Smith | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Delta | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
DeWitt | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Dickens | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Dimmit | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Donley | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Duval | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Eastland | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Ector | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Erath | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Fannin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Fayette | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Fisher | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Foard | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Franklin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Freestone | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Frio | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Gaines | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Gillespie | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Glasscock | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Goliad | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Gonzales | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Grimes | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Hall | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Hansford | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Hardeman | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Harrison | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Hartley | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Haskell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Hemphill | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Hopkins | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Houston | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Howard | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Hudspeth | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Hunt | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Jack | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Jackson | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Jeff Davis | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Jim Hogg | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Jim Wells | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Karnes | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Kenedy | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Kent | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Kerr | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
King | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Knox | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
La Salle | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Lamar | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Lavaca | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Leon | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Limestone | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Lipscomb | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Live Oak | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Loving | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Madison | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Marion | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Martin | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Matagorda | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Maverick | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Midland | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Mitchell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Montague | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Moore | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Motley | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Nolan | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Ochiltree | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Oldham | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Palo Pinto | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Panola | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Parmer | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Pecos | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Presidio | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Rains | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Real | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Reeves | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Refugio | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Roberts | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Rusk | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Scurry | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Shackelford | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Sherman | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Somervell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Starr | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Stephens | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Stonewall | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Swisher | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Terrell | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Throckmorton | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Trinity | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Upshur | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Upton | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Uvalde | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Victoria | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Ward | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Webb | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Wharton | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Wheeler | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Wichita | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Wilbarger | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Winkler | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Wise | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Yoakum | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Young | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Zapata | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in TX - H5006-014-1 Benefit Details
|
Zavala | $19.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Alleghany | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Amherst | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Appomattox | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Augusta | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Bath | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Bedford | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Bedford City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Brunswick | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Buena Vista City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Campbell | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Carroll | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Covington City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Craig | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Culpeper | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
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|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Danville City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Emporia City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
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|
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|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Floyd | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Galax City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Giles | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Greensville | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Halifax | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Harrisonburg City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Henry | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Highland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
King George | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Lexington City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Lynchburg City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Martinsville City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Mecklenburg | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Patrick | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Pittsylvania | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Pulaski | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Radford City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Rockbridge | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Rockingham | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
South Boston City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Staunton City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Waynesboro City | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in VA - H5006-014-3 Benefit Details
|
Westmoreland | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in WA - H5006-014-5 Benefit Details
|
Garfield | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
|
Sterling Option I (PFFS) in WA - H5006-014-5 Benefit Details
|
Jefferson | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
| Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
| Service | Exper. | Cost Info | |||||||||
|
Sterling Option I (PFFS) in WA - H5006-014-5 Benefit Details
|
Pacific | $69.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,000 | ||||||
|
|
|
|||||||||
Review 2011 Medicare Advantage plans
Chart Legend:
Below are a few notes to help with the understanding of the 2011 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.
Below are a few notes to help with the understanding of the 2011 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.
|
Q1 Quick Links
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