| 57424NE0010003 |
Bronze Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010003 |
Bronze Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010050 |
Bronze Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010005 |
Bronze Elite + PCP Saver Plus |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010053 |
Gold Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010036 |
Gold Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010036 |
Gold Elite |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010011 |
Secure |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010006 |
Silver Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010006 |
Silver Classic |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010052 |
Silver Classic Standard |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010045 |
Silver Simple Diabetes |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010045 |
Silver Simple Diabetes |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010025 |
Silver Simple PCP Saver |
2025 |
PREFERRED [PCP] [Dentist]
|
Oct 10, 2024 |
| 57424NE0010003 |
Bronze Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010003 |
Bronze Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010024 |
Bronze Classic 4700 |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010021 |
Bronze Classic PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010021 |
Bronze Classic PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010050 |
Bronze Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010005 |
Bronze Elite + PCP Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010053 |
Gold Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010036 |
Gold Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010036 |
Gold Elite |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010011 |
Secure |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010006 |
Silver Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010006 |
Silver Classic |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010052 |
Silver Classic Standard |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010030 |
Silver Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010030 |
Silver Elite Saver Plus |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010045 |
Silver Simple Diabetes |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010045 |
Silver Simple Diabetes |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010025 |
Silver Simple PCP Saver |
2024 |
PREFERRED [PCP] [Dentist]
|
Dec 18, 2023 |
| 57424NE0010003 |
Bronze Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010003 |
Bronze Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010024 |
Bronze Classic 4700 |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010021 |
Bronze Classic PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010021 |
Bronze Classic PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010050 |
Bronze Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010005 |
Bronze Elite + PCP Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010014 |
Bronze Simple- HSA |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010051 |
Bronze Simple- Standard |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010053 |
Gold Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010036 |
Gold Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010036 |
Gold Elite |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010011 |
Secure |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010006 |
Silver Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010006 |
Silver Classic |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010052 |
Silver Classic Standard |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010030 |
Silver Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010030 |
Silver Elite Saver Plus |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010045 |
Silver Simple Diabetes |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010045 |
Silver Simple Diabetes |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010025 |
Silver Simple PCP Saver |
2023 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010015 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2023 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010003 |
Bronze Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010003 |
Bronze Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010023 |
Bronze Classic- $3000 Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010024 |
Bronze Classic 4700 |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010021 |
Bronze Classic PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010021 |
Bronze Classic PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010002 |
Bronze Classic- PCP Saver ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010022 |
Bronze Classic- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010043 |
Bronze Elite- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010012 |
Bronze Elite- $0 Ded+Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010041 |
Bronze Elite ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010005 |
Bronze Elite + PCP Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010014 |
Bronze Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010037 |
Gold Classic- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010020 |
Gold Classic- Low Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010036 |
Gold Elite |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010036 |
Gold Elite |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010035 |
Gold Elite- $0 Ded ($0 Primary Care + $3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010033 |
Gold Simple ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010011 |
Secure |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010006 |
Silver Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010006 |
Silver Classic |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010017 |
Silver Classic- $0 Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010027 |
Silver Classic- Low Ded ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010028 |
Silver Elite- $0 PCP ($0 Primary Care + $0 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010030 |
Silver Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010030 |
Silver Elite Saver Plus |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010026 |
Silver Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010008 |
Silver Simple ($3 Preferred Generic Drugs + $0 Virtual Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010045 |
Silver Simple Diabetes |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010045 |
Silver Simple Diabetes |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010029 |
Silver Simple- HSA |
2022 |
PREFERRED
|
Sep 06, 2024 |
| 57424NE0010025 |
Silver Simple PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010025 |
Silver Simple PCP Saver |
2022 |
PREFERRED [PCP] [Dentist]
|
Sep 06, 2024 |
| 57424NE0010015 |
Silver Simple- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
2022 |
PREFERRED
|
Sep 06, 2024 |
