HMO      
 
   
 
   
  All Plans Marketed 7/1/07 and Later
Plans Including $10/$20/$35 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H02C $10 None $50 English
H11C $20 None $75 English
H17 $30 None $75 English
H14C $20 $100 $75 English
H20 $30 $250 $75 English
   
Plans Including $15/$30/$50 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H03C $10 None $50 English
H12C $20 None $75 English
H18 $30 None $75 English
H15C $20 $100 $75 English
H21 $30 $250 $75 English
   
Plans Including $15/35%/50% Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H014 $10 None $50 English
H104 $20 None $75 English
H164 $30 None $75 English
H134 $20 $100 $75 English
H194 $30 $250 $75 English
   
Plans Including $10/$40/$60 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H016 $10 None $50 English
H106 $20 None $75 English
H136 $20 $100 $75 English
H166 $30 None $75 English
H196 $30 $250 $75 English
   
  All Plans Marketed Prior to 7/1/07
Plans Including $10/$20/$35 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H02C $10 None $50 English
H11C $20 None $75 English
H17 $30 None $75 English
H14C $20 $100 $75 English
H20 $30 $250 $75 English
   
Plans Including $15/$30/$50 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H03C $10 None $50 English
H12C $20 None $75 English
H18 $30 None $75 English
H15C $20 $100 $75 English
H21 $30 $250 $75 English
   
Plans Including $15/35%/50% Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H014 $10 None $50 English
H104 $20 None $75 English
H164 $30 None $75 English
H134 $20 $100 $75 English
H194 $30 $250 $75 English
 
 
   
  All Plans Marketed Prior to 1/1/06
Plans Including $10/$20/$35 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H02 $10 None $50 English
H11 $20 None $75 English
H17 $30 None $75 English
H14 $20 $100 $75 English
H20 $30 $250 $75 English
   
Plans Including $15/$30/$50 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H03 $10 None $50 English
H12 $20 None $75 English
H18 $30 None $75 English
H15 $20 $100 $75 English
H21 $30 $250 $75 English
   
Plans Including $15/35%/50% Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H014 $10 None $50 English
H104 $20 None $75 English
H164 $30 None $75 English
H134 $20 $100 $75 English
H194 $30 $250 $75 English
   
   
   
   
   
 
  All Marketed HMO Plans for 1/1/2004 through 12/31/2004 Effective Dates
  Employee Handouts
Plans Including $10/$20/$35 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H02 $10 None $50 English
H05 $15 None $75 English
H08 $15 $100 $75 English
H11 $20 None $75 English
H17 $30 None $75 English
H14 $20 $100 $75 English
H20 $30 $250 $75 English
  HMO Drug $10/$20/$35 Spanish
   
Plans Including $15/$30/$50 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H03 $10 None $50 English
H06 $15 None $75 English
H09 $15 $100 $75 English
H12 $20 None $75 English
H15 $20 $100 $75 English
H18 $30 None $75 English
H21 $30 $250 $75 English
  HMO Drug $15/$30/$50
   
Plans Including $15/35%/50% Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H014 $10 None $50 English
H104 $20 None $75 English
H134 $20 $100 $75 English
H164 $30 None $75 English
H194 $30 $250 $75 English
  HMO Drug $15/35%/50%
   
 
  All Marketed HMO Plans for 1/1/2004 through 12/31/2004 Effective Dates
  Employer Highlight Sheets
Plans Including $10/$20/$35 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H02 $10 None $50 English
H11 $20 None $75 English
H17 $30 None $75 English
H14 $20 $100 $75 English
H20 $30 $250 $75 English
  HMO Drug $10/$20/$35 Spanish
   
Plans Including $15/$30/$50 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H03 $10 None $50 English
H12 $20 None $75 English
H18 $30 None $75 English
H15 $20 $100 $75 English
H21 $30 $250 $75 English
  HMO Drug $15/$30/$50
   
Plans Including $15/35%/50% Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan MD Office Copayment Per Day Inpatient
Hospital Copayment
Emergency Room
Copayment
Download
H014 $10 None $50 English
H104 $20 None $75 English
H164 $30 None $75 English
H134 $20 $100 $75 English
H194 $30 $250 $75 English
  HMO Drug $15/35%/50%
   
  These sheets are to utilized for spreadsheeting purposes or handouts to the employers in the presentation process. It is illegal under state law to use use these sheets as employee handouts. If doing employee meetings, the state mandates that you use the materials displayed in the employee handout format.
   
   
   
   
   
 
  Plan Designs only Available prior to 1/1/2004
Plans Including $5/$10/$25 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan Co-Pay Emergency Room
Co-Pay
Download
H01 $10 $50 English Spanish
H04 $15 $75 English Spanish
H07 $15/$100 $75 English Spanish
H10 $20 $75 English Spanish
H13 $20/$100 $75 English Spanish
  HMO
  HMO Spanish
  HMO DRUG $5/$10/$25
  HMO DRUG $5/$10/$25 Spanish
   
Plans Including $10/$20/$35 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan Co-Pay Emergency Room
Co-Pay
Download
H05 $15 $70 English Spanish
H08 $15/$100 $75 English Spanish
  HMO Drug $10/$20/$35
  HMO Drug $10/$20/$35 Spanish
   
Plans Including $15/$30/$35 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BAE PPO Plans
Plan Co-Pay Emergency Room
Co-Pay
Download
H06 $15 $75 English Spanish
H09 $15/$100 $75 English Spanish
  HMO DRUG $15/$30/$50