Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Aransas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Armstrong |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Atascosa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Bailey |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Bandera |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Bastrop |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Bee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Blanco |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Borden |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Bosque |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Briscoe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Brooks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Burnet |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Caldwell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Calhoun |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Cameron |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Castro |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Cochran |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Coke |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Collin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Colorado |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Comal |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Crosby |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Dallas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Denton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
DeWitt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Dickens |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Dimmit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Donley |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Duval |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
El Paso |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Erath |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Fayette |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Fisher |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Floyd |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Garza |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Gillespie |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Glasscock |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Goliad |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Gonzales |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Grayson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Grimes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Hale |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Hamilton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Hays |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Hidalgo |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Hill |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Hockley |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Hunt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Irion |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Jack |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Jim Hogg |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Jim Wells |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Karnes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Kendall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Kenedy |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Kent |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Kimble |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Kleberg |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Lamb |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
La Salle |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Lee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Leon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Limestone |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Lubbock |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Lynn |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
McCulloch |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
McMullen |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Martin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Mason |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Maverick |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Medina |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Milam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Mills |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Mitchell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Navarro |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Nolan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Nueces |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Palo Pinto |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Real |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Refugio |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Rockwall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
San Patricio |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
San Saba |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Shackelford |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Somervell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Starr |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Sterling |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Swisher |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Tarrant |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Terry |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Throckmorton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Uvalde |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Van Zandt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Victoria |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Webb |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Willacy |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Williamson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Wilson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Zapata |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Patriot No Premium (HMO) in TX - H5294-014-0
Benefit Details
|
Zavala |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,450 |
|
-- |
|
|