| 13877AZ0070024 |
Bronze Classic 4700 |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070024 |
Bronze Classic 4700 |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070055 |
Buena Salud Plateado Estándar Clásico |
2025 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070013 |
Gold Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070013 |
Gold Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070030 |
Silver Elite Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070030 |
Silver Elite Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070060 |
Silver Simple Chronic Care CKM |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070060 |
Silver Simple Chronic Care CKM |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070008 |
Silver Simple Specialist Saver with COPD |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070008 |
Silver Simple Specialist Saver with COPD |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 12, 2024 |
| 13877AZ0070003 |
Bronze Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070003 |
Bronze Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070002 |
Bronze Classic PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070002 |
Bronze Classic PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070013 |
Gold Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070013 |
Gold Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070006 |
Silver Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070006 |
Silver Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070030 |
Silver Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070030 |
Silver Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070008 |
Silver Simple Specialist Saver with COPD |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070008 |
Silver Simple Specialist Saver with COPD |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 13877AZ0070003 |
Bronze Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070003 |
Bronze Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070002 |
Bronze Classic PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070002 |
Bronze Classic PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070012 |
Bronze Elite- $0 Ded+Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070014 |
Bronze Simple- HSA |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070051 |
Bronze Simple- Standard |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070013 |
Gold Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070013 |
Gold Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070035 |
Gold Elite- $0 Ded ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070036 |
Gold Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070006 |
Silver Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070006 |
Silver Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070017 |
Silver Classic- $0 Ded |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070028 |
Silver Elite- $0 PCP ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070030 |
Silver Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070030 |
Silver Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070045 |
Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070008 |
Silver Simple Specialist Saver with COPD |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070008 |
Silver Simple Specialist Saver with COPD |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070003 |
Bronze Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070003 |
Bronze Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070021 |
Bronze Classic- $0 PCP ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070023 |
Bronze Classic- $3000 Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070040 |
Bronze Classic- $5000 Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070002 |
Bronze Classic PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070002 |
Bronze Classic PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070022 |
Bronze Classic- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070043 |
Bronze Elite- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070012 |
Bronze Elite- $0 Ded+Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070042 |
Bronze Elite- $1000 Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070041 |
Bronze Elite ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070014 |
Bronze Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070013 |
Gold Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070013 |
Gold Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070035 |
Gold Elite- $0 Ded ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070036 |
Gold Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070006 |
Silver Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070006 |
Silver Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070017 |
Silver Classic- $0 Ded |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070027 |
Silver Classic- Low Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070028 |
Silver Elite- $0 PCP ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070030 |
Silver Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070030 |
Silver Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070026 |
Silver Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070015 |
Silver Simple ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070045 |
Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070044 |
Silver Simple- High Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070029 |
Silver Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 13877AZ0070025 |
Silver Simple PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070025 |
Silver Simple PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070008 |
Silver Simple Specialist Saver with COPD |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 13877AZ0070008 |
Silver Simple Specialist Saver with COPD |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
