Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Aitkin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Carlton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Cook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Goodhue |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Itasca |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Kanabec |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Koochiching |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Le Sueur |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in MN - H2450-044-0
Benefit Details
|
McLeod |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Meeker |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Mille Lacs |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Pine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Pipestone |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Rice |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Rock |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
St. Louis |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Sibley |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Stevens |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Traverse |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in MN - H2450-044-0
Benefit Details
|
Yellow Medicine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Adams |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Barnes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Benson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Billings |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Bowman |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Burleigh |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Cass |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Cavalier |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Dickey |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Dunn |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Eddy |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Emmons |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Foster |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Grand Forks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Grant |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Griggs |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Hettinger |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Kidder |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
LaMoure |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Logan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
McHenry |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
McIntosh |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
McLean |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Mercer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Morton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Nelson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Oliver |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Pembina |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Pierce |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Ramsey |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Ransom |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Richland |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Rolette |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Sargent |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Sheridan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Sioux |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Slope |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Stark |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Steele |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Stutsman |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Towner |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Traill |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Walsh |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Ward |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Wells |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in ND - H2450-044-0
Benefit Details
|
Williams |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Aurora |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Beadle |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Bennett |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Bon Homme |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Brookings |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Brown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Brule |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Buffalo |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Butte |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Campbell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Charles Mix |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Clark |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Clay |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Codington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Corson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Custer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Davison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Day |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Deuel |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Dewey |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Douglas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
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|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Edmunds |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
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Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Fall River |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Faulk |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Grant |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Gregory |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Haakon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Hamlin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
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|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Hand |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Hanson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Harding |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Hughes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Hutchinson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Hyde |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Jackson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Jerauld |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Jones |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Kingsbury |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Lawrence |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Lincoln |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Lyman |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
McCook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
McPherson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Marshall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Meade |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Mellette |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Miner |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Minnehaha |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Moody |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Oglala Lakota |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Pennington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Perkins |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Potter |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Roberts |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Sanborn |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Spink |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Stanley |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Sully |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Todd |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Tripp |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Turner |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Union |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Walworth |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
Medica Prime Solution Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Yankton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|
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 Standard (Cost) in SD - H2450-044-0
Benefit Details
|
Ziebach |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 |
|
|
|
|