Health Alliance Medicare HMO 20 Rx (HMO) in IA - H1463-003-0
Benefits & Contact Info
|
Scott |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Boone |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Brown |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Bureau |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Carroll |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Cass |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Champaign |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Christian |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Clark |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Clay |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Coles |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Crawford |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Cumberland |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
DeKalb |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
De Witt |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Douglas |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Edgar |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Edwards |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Effingham |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Fayette |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Ford |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Franklin |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Fulton |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Grundy |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Hancock |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Henderson |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Henry |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Iroquois |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Jackson |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Jasper |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Jefferson |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Jo Daviess |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Johnson |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Kankakee |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Knox |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
La Salle |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Lawrence |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Lee |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Livingston |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Logan |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
McDonough |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
McLean |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Macon |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Macoupin |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Marion |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Marshall |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Mason |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Menard |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Mercer |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Montgomery |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Morgan |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Moultrie |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Ogle |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Peoria |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Perry |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Piatt |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Pike |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Putnam |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Richland |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Rock Island |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Saline |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Sangamon |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Schuyler |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Scott |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Shelby |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Stark |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Stephenson |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Tazewell |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Vermilion |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Wabash |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Warren |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Wayne |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Whiteside |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Williamson |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Winnebago |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IL - H1463-003-0
Benefits & Contact Info
|
Woodford |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Benton |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Daviess |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Fayette |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Fountain |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Franklin |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Henry |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Knox |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Newton |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Pike |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Randolph |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Union |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 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 |
Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Vermillion |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Warren |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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Health Alliance Medicare HMO 20 Rx (HMO) in IN - H1463-003-0
Benefits & Contact Info
|
Wayne |
$125.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $4,000 Browse Formulary |
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