| 23552TN0020024 |
Bronze Classic 4700 |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020024 |
Bronze Classic 4700 |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020013 |
Gold Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020013 |
Gold Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020036 |
Gold Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020036 |
Gold Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020006 |
Silver Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020006 |
Silver Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020056 |
Silver Simple Breathe Easy with Enhanced COPD Benefits |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020056 |
Silver Simple Breathe Easy with Enhanced COPD Benefits |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020055 |
Silver Simple Diabetes |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020055 |
Silver Simple Diabetes |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 17, 2024 |
| 23552TN0020024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020021 |
Bronze Classic PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020021 |
Bronze Classic PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020051 |
Bronze Simple 2 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020051 |
Bronze Simple 2 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020013 |
Gold Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020013 |
Gold Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020036 |
Gold Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020036 |
Gold Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020006 |
Silver Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020006 |
Silver Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020056 |
Silver Simple Breathe Easy with Enhanced COPD Benefits |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020056 |
Silver Simple Breathe Easy with Enhanced COPD Benefits |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020055 |
Silver Simple Diabetes |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020055 |
Silver Simple Diabetes |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 16, 2023 |
| 23552TN0020003 |
Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020021 |
Bronze Classic PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020021 |
Bronze Classic PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020012 |
Bronze Elite- $0 Ded+Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020001 |
Bronze Simple ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020051 |
Bronze Simple 2 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020051 |
Bronze Simple 2 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020014 |
Bronze Simple- HSA |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020013 |
Gold Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020013 |
Gold Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020036 |
Gold Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020036 |
Gold Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020035 |
Gold Elite- $0 Ded ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020006 |
Silver Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020006 |
Silver Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020017 |
Silver Classic- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020016 |
Silver Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020008 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020023 |
Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020003 |
Bronze Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020021 |
Bronze Classic PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020021 |
Bronze Classic PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020012 |
Bronze Elite- $0 Ded+Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020001 |
Bronze Simple ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020014 |
Bronze Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020013 |
Gold Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020013 |
Gold Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020037 |
Gold Classic- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020006 |
Silver Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020006 |
Silver Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 23552TN0020017 |
Silver Classic- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020016 |
Silver Elite ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 23552TN0020008 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
