2012 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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WindsorSterling Silver Connect Plan (PFFS) in CO - H3410-002-7 Benefit Details |
Custer | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in CO - H3410-002-7 Benefit Details |
El Paso | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in CO - H3410-002-7 Benefit Details |
Pueblo | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in ID - H3410-002-8 Benefit Details |
Benewah | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in ID - H3410-002-8 Benefit Details |
Bonner | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in ID - H3410-002-8 Benefit Details |
Boundary | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in ID - H3410-002-8 Benefit Details |
Kootenai | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in ID - H3410-002-8 Benefit Details |
Shoshone | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in IL - H3410-002-9 Benefit Details |
St. Clair | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in KS - H3410-002-10 Benefit Details |
Johnson | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in KS - H3410-002-10 Benefit Details |
Wyandotte | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Acadia | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Allen | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Ascension | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Bienville | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Claiborne | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Jefferson | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Lafayette | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Lincoln | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Livingston | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Orleans | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Ouachita | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Red River | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
St. James | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
St. Landry | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Tangipahoa | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Vermilion | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in LA - H3410-002-11 Benefit Details |
Winn | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in MO - H3410-002-12 Benefit Details |
Jackson | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in MO - H3410-002-12 Benefit Details |
St. Louis | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in MO - H3410-002-12 Benefit Details |
St. Louis City | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in MT - H3410-002-13 Benefit Details |
Cascade | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in MT - H3410-002-13 Benefit Details |
Lewis and Clark | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in MT - H3410-002-13 Benefit Details |
Yellowstone | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in NC - H3410-002-14 Benefit Details |
Durham | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in NC - H3410-002-14 Benefit Details |
Orange | $49.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Canadian | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Creek | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Logan | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Mayes | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Oklahoma | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Pottawatomie | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Rogers | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Seminole | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Tulsa | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Wagoner | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in OK - H3410-002-15 Benefit Details |
Washington | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Abbeville | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Anderson | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Berkeley | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Charleston | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Cherokee | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Colleton | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Dorchester | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Greenville | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Horry | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Lancaster | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Lexington | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Marion | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
McCormick | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Oconee | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Pickens | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Richland | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Spartanburg | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in SC - H3410-002-16 Benefit Details |
Union | $35.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in TX - H3410-002-17 Benefit Details |
Cherokee | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in TX - H3410-002-17 Benefit Details |
Hill | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in TX - H3410-002-17 Benefit Details |
Hood | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in TX - H3410-002-17 Benefit Details |
Van Zandt | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in TX - H3410-002-17 Benefit Details |
Wood | $29.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in UT - H3410-002-18 Benefit Details |
Salt Lake | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in UT - H3410-002-18 Benefit Details |
Weber | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Benton | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Clark | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Island | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Jefferson | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
King | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Kittitas | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
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 | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Lewis | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Lincoln | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Mason | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Okanogan | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Pend Oreille | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Pierce | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Skagit | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Snohomish | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Spokane | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- | ||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
WindsorSterling Silver Connect Plan (PFFS) in WA - H3410-002-19 Benefit Details |
Whatcom | $30.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
-- | -- |
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