Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Autauga |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Baldwin |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Barbour |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Bibb |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Blount |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Bullock |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Butler |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Calhoun |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Chambers |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Cherokee |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Chilton |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Choctaw |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Clarke |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Clay |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Cleburne |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Coffee |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Colbert |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Conecuh |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Coosa |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Covington |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Crenshaw |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Cullman |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Dale |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Dallas |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
DeKalb |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Elmore |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Escambia |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Etowah |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Fayette |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Franklin |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Geneva |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Greene |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Hale |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Henry |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Houston |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Jackson |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Jefferson |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Lamar |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Lauderdale |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Lawrence |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Lee |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Limestone |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Lowndes |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Macon |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Madison |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Marengo |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Marion |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Marshall |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Mobile |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Monroe |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Montgomery |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Morgan |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Perry |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Pickens |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Pike |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Randolph |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Russell |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
St. Clair |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Shelby |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Sumter |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Talladega |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Tallapoosa |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Tuscaloosa |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Walker |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Washington |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Wilcox |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Simpra Advantage Premier (PPO I-SNP) in AL - H4091-003-0
Benefit Details
|
Winston |
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30%
all covered insulin pay $35 or less | n/a Browse Formulary |
|
-- |
|
|