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  HMO Plan Map Chart
 
   
  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 BA HMO Value Choice Plans
Plan MD/WELLNESS/Specialist Office Copayment

1st 3
Days/CALENDAR YR Inpatient
Hospital Copayment

 Emergency Room
Copayment		 Download
VO22 $40/$15/$60 $500 $250 English
VO32 $50/$20/$70 $750 $300 English
   
Plans Including $15/$30/$50 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BA HMO Value Choice Plans
Plan MD/WELLNESS/Specialist Office Copayment

1st 3
Days/CALENDAR YR Inpatient
Hospital Copayment

 Emergency Room
Copayment		 Download
VO23 $40/$15/$60 $500 $250 English
VO33 $50/$20/$70 $750 $300 English
   
Plans Including $15/35%/50% Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BA HMO Value Choice Plans
Plan MD/WELLNESS/Specialist Office Copayment

1st 3
Days/CALENDAR YR Inpatient
Hospital Copayment

 Emergency Room
Copayment		 Download
VO24 $40/$15/$60 $500 $250 English
VO34 $50/$20/$70 $750 $300 English
   
Plans Including $10/$40/$60 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BA HMO Value Choice Plans
Plan MD/WELLNESS/Specialist Office Copayment

1st 3
Days/CALENDAR YR Inpatient
Hospital Copayment

 Emergency Room
Copayment		 Download
VO26 $40/$15/$60 $500 $250 English
VO36 $50/$20/$70 $750 $300 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 BA HMO Value Choice Plans
Plan MD/WELLNESS/Specialist Office Copayment

1st 3
Days/CALENDAR YR Inpatient
Hospital Copayment

 Emergency Room
Copayment		 Download
VO22 $40/$15/$60 $500 $250 English
VO32 $50/$20/$70 $750 $300 English
   
Plans Including $15/$30/$50 Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BA HMO Value Choice Plans
Plan MD/WELLNESS/Specialist Office Copayment

1st 3
Days/CALENDAR YR Inpatient
Hospital Copayment

 Emergency Room
Copayment		 Download
VO23 $40/$15/$60 $500 $250 English
VO33 $50/$20/$70 $750 $300 English
   
Plans Including $15/35%/50% Copay Drug Card
Option Highlight Sheet
This Drug Card services the following BA HMO Value Choice Plans
Plan MD/WELLNESS/Specialist Office Copayment

1st 3
Days/CALENDAR YR Inpatient
Hospital Copayment

 Emergency Room
Copayment		 Download
VO24 $40/$15/$60 $500 $250 English
VO34 $50/$20/$70 $750 $300 English