The Health Plan SecureChoice - Option II (PPO) in OH - H8604-011-0
Benefits & Contact Info
|
Belmont |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in OH - H8604-011-0
Benefits & Contact Info
|
Guernsey |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in OH - H8604-011-0
Benefits & Contact Info
|
Harrison |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in OH - H8604-011-0
Benefits & Contact Info
|
Jefferson |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in OH - H8604-011-0
Benefits & Contact Info
|
Monroe |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in OH - H8604-011-0
Benefits & Contact Info
|
Muskingum |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in OH - H8604-011-0
Benefits & Contact Info
|
Noble |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in OH - H8604-011-0
Benefits & Contact Info
|
Washington |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Barbour |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Berkeley |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Braxton |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Brooke |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Cabell |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Calhoun |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Doddridge |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Gilmer |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Grant |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Greenbrier |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Hampshire |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Hancock |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Hardy |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Harrison |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Jefferson |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Lewis |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Lincoln |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Logan |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
McDowell |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Marion |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Marshall |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Mason |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Mercer |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Mineral |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Mingo |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Monongalia |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Monroe |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Morgan |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Nicholas |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Ohio |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Pendleton |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Pleasants |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Pocahontas |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Preston |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Raleigh |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Randolph |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Ritchie |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Roane |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Summers |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Taylor |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Tucker |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Tyler |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Upshur |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Wayne |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Webster |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Wetzel |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Wirt |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Wood |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
The Health Plan SecureChoice - Option II (PPO) in WV - H8604-011-0
Benefits & Contact Info
|
Wyoming |
$153.40 |
$100 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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