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PPO Plans Marketed 7/1/2007 and Later

*7/1/08 Effective Dates
 
Plans Including 10/20/35 Copay Drug Card
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
102C 0 100/80 10 English
108C 250 100/80 10 English
111C 500 100/80 10 English
12312 0 90/70 10 English
42312 250 90/70 10 English
72312 500 90/70 10 English
82312 1000 90/70 10 English
92412 1500 90/70 10 English
C2412 2500 90/70 10 English
12322 0 90/70 20 English
42322 250 90/70 20 English
72322 500 90/70 20 English
82322 1000 90/70 20 English
92422 1500 90/70 20 English
C2422 2500 90/70 20 English
43422 250 80/60 20 English
73422 500 80/60 20 English
83422 1000 80/60 20 English
93422 1500 80/60 20 English
C3422 2500 80/60 20 English
43432 250 80/60 30 English
73432 500 80/60 30 English
83432 1000 80/60 30 English
93432 1500 80/60 30 English
C3432 2500 80/60 30 English
*E2412 3500 90/70 10 English
*E2422 3500 90/70 20 English
*E3422 3500 80/60 20 English
*E3432 3500 80/60 30 English
   
 
Plans Including 15/30/50 Copay Drug Card
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
103C 0 100/80 10 English
109C 250 100/80 10 English
112C 500 100/80 10 English
12313 0 90/70 10 English
42313 250 90/70 10 English
72313 500 90/70 10 English
82313 1000 90/70 10 English
92413 1500 90/70 10 English
C2413 2500 90/70 10 English
12323 0 90/70 20 English
42323 250 90/70 20 English
72323 500 90/70 20 English
82323 1000 90/70 20 English
92423 1500 90/70 20 English
C2423 2500 90/70 20 English
43423 250 80/60 20 English
73423 500 80/60 20 English
83423 1000 80/60 20 English
93423 1500 80/60 20 English
C3423 2500 80/60 20 English
43433 250 80/60 30 English
73433 500 80/60 30 English
83433 1000 80/60 30 English
93433 1500 80/60 30 English
C3433 2500 80/60 30 English
*E2413 3500 90/70 10 English
*E2423 3500 90/70 20 English
*E3423 3500 80/60 20 English
*E3433 3500 80/60 30 English
   
 
Plans Including 10/40/60 Copay Drug Card
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
43426 250 80/60 20 English
73426 500 80/60 20 English
83426 1000 80/60 20 English
93426 1500 80/60 20 English
C3426 2500 80/60 20 English
43436 250 80/60 30 English
73436 500 80/60 30 English
83436 1000 80/60 30 English
93436 1500 80/60 30 English
C3436 2500 80/60 30 English
11116 0 100/80 10 English
12316 0 90/70 10 English
12326 0 90/70 20 English
41116 250 100/80 10 English
42316 250 90/70 10 English
42326 250 90/70 20 English
71116 500 100/80 10 English
72316 500 90/70 10 English
72326 500 90/70 20 English
82316 1000 90/70 10 English
82326 1000 90/70 20 English
92416 1500 90/70 10 English
92426 1500 90/70 20 English
C2416 2500 90/70 10 English
C2426 2500 90/70 20 English
*E2416 3500 90/70 10 English
*E2426 3500 90/70 20 English
*E3426 3500 80/60 20 English
*E3436 3500 80/60 30 English
   
   
  PPO Plans Marketed Prior to 7/1/2007
 
Plans Including 10/20/35 Copay Drug Card
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
102C 0 100/80 10 English
108C 250 100/80 10 English
111C 500 100/80 10 English
12312 0 90/70 10 English
42312 250 90/70 10 English
72312 500 90/70 10 English
82312 1000 90/70 10 English
92412 1500 90/70 10 English
C2412 2500 90/70 10 English
12322 0 90/70 20 English
42322 250 90/70 20 English
72322 500 90/70 20 English
82322 1000 90/70 20 English
92422 1500 90/70 20 English
C2422 2500 90/70 20 English
43422 250 80/60 20 English
73422 500 80/60 20 English
83422 1000 80/60 20 English
93422 1500 80/60 20 English
C3422 2500 80/60 20 English
43432 250 80/60 30 English
73432 500 80/60 30 English
83432 1000 80/60 30 English
93432 1500 80/60 30 English
C3432 2500 80/60 30 English
   
 
Plans Including 15/30/50 Copay Drug Card
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
103C 0 100/80 10 English
109C 250 100/80 10 English
112C 500 100/80 10 English
12313 0 90/70 10 English
42313 250 90/70 10 English
72313 500 90/70 10 English
82313 1000 90/70 10 English
92413 1500 90/70 10 English
C2413 2500 90/70 10 English
12323 0 90/70 20 English
42323 250 90/70 20 English
72323 500 90/70 20 English
82323 1000 90/70 20 English
92423 1500 90/70 20 English
C2423 2500 90/70 20 English
43423 250 80/60 20 English
73423 500 80/60 20 English
83423 1000 80/60 20 English
93423 1500 80/60 20 English
C3423 2500 80/60 20 English
43433 250 80/60 30 English
73433 500 80/60 30 English
83433 1000 80/60 30 English
93433 1500 80/60 30 English
C3433 2500 80/60 30 English
   
 
Plans Including 15/35%/50% Copay Drug Card
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
43424 250 80/60 20 English
73424 500 80/60 20 English
83424 1000 80/60 20 English
93424 1500 80/60 20 English
C3424 2500 80/60 20 English
43434 250 80/60 30 English
73434 500 80/60 30 English
83434 1000 80/60 30 English
93434 1500 80/60 30 English
C3434 2500 80/60 30 English
   
  PPO Plans Marketed 1/1/2006
Plans Including 10/20/35 Copay Drug Card (english)
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
102C 0 100/80 10 English
108C 250 100/80 10 English
111C 500 100/80 10 English
12312 0 90/70 10 English
42312 250 90/70 10 English
72312 500 90/70 10 English
82312 1000 90/70 10 English
92412 1500 90/70 10 English
C2412 2500 90/70 10 English
12322 0 90/70 20 English
42322 250 90/70 20 English
72322 500 90/70 20 English
82322 1000 90/70 20 English
92422 1500 90/70 20 English
C2422 2500 90/70 20 English
43422 250 80/60 20 English
73422 500 80/60 20 English
83422 1000 80/60 20 English
93422 1500 80/60 20 English
C3422 2500 80/60 20 English
43432 250 80/60 30 English
73432 500 80/60 30 English
83432 1000 80/60 30 English
93432 1500 80/60 30 English
C3432 2500 80/60 30 English
   
Plans Including 15/30/50 Copay Drug Card (english)
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
103C 0 100/80 10 English
109C 250 100/80 10 English
112C 500 100/80 10 English
12313 0 90/70 10 English
42313 250 90/70 10 English
72313 500 90/70 10 English
82313 1000 90/70 10 English
92413 1500 90/70 10 English
C2413 2500 90/70 10 English
12323 0 90/70 20 English
42323 250 90/70 20 English
72323 500 90/70 20 English
82323 1000 90/70 20 English
92423 1500 90/70 20 English
C2423 2500 90/70 20 English
43423 250 80/60 20 English
73423 500 80/60 20 English
83423 1000 80/60 20 English
93423 1500 80/60 20 English
C3423 2500 80/60 20 English
43433 250 80/60 30 English
73433 500 80/60 30 English
83433 1000 80/60 30 English
93433 1500 80/60 30 English
C3433 2500 80/60 30 English
   
Plans Including 15/35%/50% Copay Drug Card (english)
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
43424 250 80/60 20 English
73424 500 80/60 20 English
83424 1000 80/60 20 English
93424 1500 80/60 20 English
C3424 2500 80/60 20 English
43434 250 80/60 30 English
73434 500 80/60 30 English
83434 1000 80/60 30 English
93434 1500 80/60 30 English
C3434 2500 80/60 30 English
   
  PPO Plans Marketed Prior to 1/1/2006
Plans Including 10/20/35 Copay Drug Card (english)
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
102 0 100/80 10 English
108 250 100/80 10 English
111 500 100/80 10 English
12312 0 90/70 10 English
42312 250 90/70 10 English
72312 500 90/70 10 English
82312 1000 90/70 10 English
92412 1500 90/70 10 English
C2412 2500 90/70 10 English
12322 0 90/70 20 English
42322 250 90/70 20 English
72322 500 90/70 20 English
82322 1000 90/70 20 English
92422 1500 90/70 20 English
C2422 2500 90/70 20 English
43422 250 80/60 20 English
73422 500 80/60 20 English
83422 1000 80/60 20 English
93422 1500 80/60 20 English
C3422 2500 80/60 20 English
43432 250 80/60 30 English
73432 500 80/60 30 English
83432 1000 80/60 30 English
93432 1500 80/60 30 English
C3432 2500 80/60 30 English
   
Plans Including 15/30/50 Copay Drug Card (english)
Option Highlight Sheet
Plan Deductible CO-Insurance CO-Pay Download
103 0 100/80 10 English
109 250 100/80 10 English
112 500 100/80 10 English
12313 0 90/70 10 English
42313 250 90/70 10 English
72313 500 90/70 10 English
82313 1000 90/70 10 English
92413 1500 90/70 10 English
C2413 2500 90/70 10 English
12323 0 90/70 20 English
42323 250 90/70 20 English
72323 500 90/70 20 English
82323 1000 90/70 20