Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Adams |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Allamakee |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Cass |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Clay |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Dickinson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Emmet |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Fremont |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Howard |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Lyon |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Mitchell |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Monona |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Montgomery |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
O'Brien |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Osceola |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Plymouth |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Shelby |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Sioux |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Winnebago |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in IA - H2450-030-0
Benefit Details
|
Worth |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Chase |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Elk |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Greenwood |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Harper |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Jewell |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Kingman |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Mitchell |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Morris |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Norton |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Osage |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Phillips |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Republic |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Smith |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Wabaunsee |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in KS - H2450-030-0
Benefit Details
|
Washington |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Aitkin |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Carlton |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Cook |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Goodhue |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Itasca |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Kanabec |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Koochiching |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Lake |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Le Sueur |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
McLeod |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Meeker |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Mille Lacs |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Pine |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Pipestone |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Rice |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Rock |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
St. Louis |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Sibley |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Stevens |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Traverse |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in MN - H2450-030-0
Benefit Details
|
Yellow Medicine |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Adams |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Barnes |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Benson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Billings |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Bowman |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Burleigh |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Cass |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Cavalier |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Dickey |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Dunn |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Eddy |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Emmons |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Foster |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Grand Forks |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Grant |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Griggs |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Hettinger |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Kidder |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
LaMoure |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Logan |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
McHenry |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
McIntosh |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
McLean |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Mercer |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Morton |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Nelson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Oliver |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Pembina |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Pierce |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Ramsey |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Ransom |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Richland |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Rolette |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Sargent |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Sheridan |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Sioux |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Slope |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Stark |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Steele |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Stutsman |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Towner |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Traill |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Walsh |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Ward |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Wells |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in ND - H2450-030-0
Benefit Details
|
Williams |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Adams |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Antelope |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Boone |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Boyd |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Buffalo |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Burt |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Cedar |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Cheyenne |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Clay |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Colfax |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Cuming |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Custer |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Dawes |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Dixon |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Fillmore |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Franklin |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Frontier |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Furnas |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Gage |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Garfield |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Gosper |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Greeley |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Hall |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Hamilton |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Harlan |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Holt |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Howard |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Jefferson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Johnson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Kearney |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Knox |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Loup |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Madison |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Merrick |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Nance |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Nemaha |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Nuckolls |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Otoe |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Pawnee |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Phelps |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Pierce |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Platte |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Rock |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Saline |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Seward |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Sherman |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Stanton |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Thayer |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Thurston |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Valley |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Wayne |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Webster |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
Wheeler |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in NE - H2450-030-0
Benefit Details
|
York |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Aurora |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Beadle |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Bennett |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Bon Homme |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Brookings |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Brown |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Brule |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Buffalo |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Butte |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Campbell |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Charles Mix |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Clark |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Clay |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Codington |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Corson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Custer |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Davison |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Day |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Deuel |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Dewey |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Douglas |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Edmunds |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Fall River |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Faulk |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Grant |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Gregory |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Haakon |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Hamlin |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Hand |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Hanson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Harding |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Hughes |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Hutchinson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Hyde |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Jackson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Jerauld |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Jones |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Kingsbury |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Lake |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Lawrence |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Lincoln |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Lyman |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
McCook |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
McPherson |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Marshall |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Meade |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Mellette |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Miner |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Minnehaha |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Moody |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Oglala Lakota |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Pennington |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Perkins |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Potter |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Roberts |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Sanborn |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Spink |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Stanley |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Sully |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Todd |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Tripp |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Turner |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Union |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Walworth |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Yankton |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in SD - H2450-030-0
Benefit Details
|
Ziebach |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Ashland |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Barron |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Bayfield |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Burnett |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Chippewa |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Douglas |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Dunn |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Eau Claire |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Pierce |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Polk |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
St. Croix |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Sawyer |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Medica Prime Solution Thrift (Cost) in WI - H2450-030-0
Benefit Details
|
Washburn |
$34.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|