Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Anderson |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Bledsoe |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Blount |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Bradley |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Campbell |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Carter |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Claiborne |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Cocke |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Crockett |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Dyer |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Fayette |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Grainger |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Greene |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Grundy |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Hamblen |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Hamilton |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Hancock |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Hardeman |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Hawkins |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Haywood |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Jefferson |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Johnson |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Knox |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Lake |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Lauderdale |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Loudon |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Marion |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
McMinn |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
McNairy |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Meigs |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Monroe |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Morgan |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Obion |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Polk |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Rhea |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Roane |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Scott |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Sequatchie |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Sevier |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Shelby |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Sullivan |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Tipton |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Unicoi |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Union |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Washington |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Emerald Value (HMO) in TN - H5698-062-0
Benefit Details
|
Weakley |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $15.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|