Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Bond |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Boone |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Brown |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Bureau |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Calhoun |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Cass |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Champaign |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Clark |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Clay |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Coles |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Cook |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Cumberland |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
DeKalb |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
De Witt |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Douglas |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
DuPage |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Edgar |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Effingham |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Fayette |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Ford |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Franklin |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Fulton |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Gallatin |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Greene |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Grundy |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Hamilton |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Hancock |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Hardin |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Henderson |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Henry |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Iroquois |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Jackson |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Jasper |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Jefferson |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Jersey |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Kane |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Kankakee |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Kendall |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Knox |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
La Salle |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Lee |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Livingston |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Logan |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
McHenry |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
McLean |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Macoupin |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Madison |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Marion |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Marshall |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Mason |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Mercer |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Monroe |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Morgan |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Moultrie |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Ogle |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Peoria |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
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Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Perry |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Piatt |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Pike |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Putnam |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Randolph |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Rock Island |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Saline |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Schuyler |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Scott |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Shelby |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Stark |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Stephenson |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Tazewell |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Union |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Vermilion |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Warren |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Washington |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Wayne |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
White |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Whiteside |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Will |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Winnebago |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist (HMO) in IL - H5779-008-0
Benefit Details
|
Woodford |
$12.30 |
$480 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 41% Specialty Tier: 25% Select Care Drugs: $0.00
| $3,450 Browse Formulary |
|
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