WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Baldwin |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Barrow |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Bartow |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Bibb |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Bleckley |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Brantley |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Bryan |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Burke |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Butts |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Camden |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Carroll |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Chatham |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Chattahoochee |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Cherokee |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Clarke |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Clayton |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Cobb |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Columbia |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Coweta |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Crawford |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
DeKalb |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Dodge |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Dooly |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Douglas |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Emanuel |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Fayette |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Forsyth |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Fulton |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Glascock |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Glynn |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Greene |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Gwinnett |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Haralson |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Harris |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Heard |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Henry |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Houston |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Jasper |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Jefferson |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Jenkins |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Johnson |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Jones |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Lamar |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Liberty |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Lincoln |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Long |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
McDuffie |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
McIntosh |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Macon |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Marion |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Meriwether |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Monroe |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Morgan |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Muscogee |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Newton |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Oconee |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Paulding |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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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 |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Peach |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Pickens |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Pike |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Polk |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Pulaski |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Putnam |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Richmond |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Rockdale |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Screven |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Spalding |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Stewart |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Talbot |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Treutlen |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Troup |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Twiggs |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Upson |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Walton |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Warren |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Washington |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Wayne |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
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WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Wheeler |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Wilkes |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
|
WellCare Dividend (HMO) in GA - H1112-042-0
Benefit Details
|
Wilkinson |
$0.00 |
$200 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 29%
| $6,700 Browse Formulary |
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