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Summary of Benefits & Coverage

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Last Updated: Sep 25, 2023

Last Updated: Sep 25, 2023

Preferred Provider Organization (PPO) Plan 256: 80% In-Network Coinsurance, 60% Out-of-Network Coinsurance; w/ BlueCard - Prescription Drug: Fixed Co-Pay $15/$35/$50 Rx

Last Updated: Sep 25, 2023

Preferred Provider Organization (PPO) Plan 335: 100% In-Network Coinsurance, 80% Out-of-Network Coinsurance; w/ BlueCard - Prescription Drug: Co-Insurance Co-Pay 70%/30% Rx

Last Updated: Oct 31, 2022

Preferred Provider Organization (PPO) Plan 37: 80% In-Network Coinsurance, 60% Out-of-Network Coinsurance; w/ BlueCard - Prescription Drug: MMRx

Last Updated: Sep 25, 2023

Preferred Provider Organization (PPO) Plan 401: 80% In-Network Coinsurance, 60% Out-of-Network Coinsurance; w/ BlueCard - Prescription Drug: Fixed Co-Pay $15/$25 Rx

Last Updated: Sep 25, 2023

Preferred Provider Organization (PPO) Plan 406: 80% In-Network Coinsurance, 60% Out-of-Network Coinsurance; w/ BlueCard - Prescription Drug: Fixed Co-Pay $15/$35/$50 Rx

Last Updated: Sep 25, 2023

MyWay HSA Direct Access 80/60 - $15/$35/$50 Rx (CDHRx) Plan 608

Last Updated: Sep 25, 2023

MyWay HSA Direct Access 80/60 - $15/$35/$50 Rx (CDHRx) Plan 608L

Last Updated: Oct 31, 2022

MyWay HSA Direct Access 80/60 - $15/$35/$50 Rx (CDHRx) Plan 609

Last Updated: Sep 25, 2023

MyWay HSA Direct Access 80/60 - $15/$35/$50 Rx (CDHRx) Plan 609L

Last Updated: Oct 31, 2022

611, HSA, Direct Access

Last Updated: Sep 25, 2023

611L, HSA, Direct Access

Last Updated: Oct 31, 2022

MyWay HSA Direct Access 100/70 - $15/$35/$50 Rx (CDHRx) Plan 618

Last Updated: Nov 15, 2023

MyWay HSA Direct Access 100/70 - $15/$35/$50 Rx (CDHRx) Plan 618L

Last Updated: Oct 31, 2022

MyWay HSA Direct Access 100/70 - $15/$35/$50 Rx (CDHRx) Plan 619

Last Updated: Sep 25, 2023

MyWay HSA Direct Access 100/70 - $15/$35/$50 Rx (CDHRx) Plan 619L

Last Updated: Oct 31, 2022

MyWay HSA Direct Access 100% - $15/$35/$50 Rx (CDHRx) Plan 620

Last Updated: Nov 15, 2023

MyWay HSA Direct Access 100% - $15/$35/$50 Rx (CDHRx) Plan 621

Last Updated: Sep 25, 2023

Direct Access EPO - 100% Network Only - Fixed Co-Pay $15/$25 Rx Plan 811

Last Updated: Sep 25, 2023

Direct Access EPO - 100% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 815

Last Updated: Sep 25, 2023

Direct Access EPO - 100% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 816

Last Updated: Sep 25, 2023

Direct Access EPO - 100% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 817

Last Updated: Oct 31, 2022

Direct Access EPO - 80% Network Only - Fixed Co-Pay $15/$25 Rx Plan 821

Last Updated: Sep 25, 2023

Direct Access EPO - 80% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 825

Last Updated: Sep 25, 2023

Direct Access EPO - 80% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 826

Last Updated: Sep 25, 2023

Direct Access EPO - 80% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 827

Last Updated: Oct 31, 2022

Direct Access EPO - 80% Network Only - Fixed Co-Pay $15/$25 Rx Plan 831

Last Updated: Oct 31, 2022

Direct Access EPO - 80% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 835

Last Updated: Oct 31, 2022

Direct Access EPO - 80% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 836

Last Updated: Sep 25, 2023

Direct Access EPO - 80% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 837

Last Updated: Sep 25, 2023

Direct Access EPO - 80% Network Only - Fixed Co-Pay $15/$25 Rx Plan 841

Last Updated: Sep 25, 2023

Direct Access EPO - 80% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 845

Last Updated: Oct 31, 2022

Direct Access EPO - 80% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 846

Last Updated: Sep 25, 2023

Direct Access EPO - 80% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 847

Last Updated: Sep 25, 2023

Direct Access EPO - 100% Network Only - Fixed Co-Pay $15/$25 Rx Plan 851

Last Updated: Sep 25, 2023

Direct Access EPO - 100% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 855

Last Updated: Oct 31, 2022

Summary of Benefits and Coverage - Direct Access EPO - 100% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 856

Last Updated: Sep 25, 2023

Summary of Benefits and Coverage - Direct Access EPO - 100% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 857

Last Updated: Sep 25, 2023

Summary of Benefits and Coverage - DA EPO - 50% Network Only Plan 861 2Teir $15/$25 Rx

Last Updated: Oct 31, 2022

Summary of Benefits and Coverage - DA EPO - 50% Plan 865 70%/30% Rx, Network Only

Last Updated: Oct 31, 2022

Summary of Benefits and Coverage - DA EPO - 50% Network Only Plan 866 3Tier $15/$35/$50 Rx

Last Updated: Nov 15, 2023

Summary of Benefits and Coverage - DA EPO - 50% Plan 867 50% Rx, Network Only

Last Updated: Sep 25, 2023

873, EPO, In Network Only

Last Updated: Oct 31, 2022

Summary of Benefits and Coverage - DA EPO - 50% Network Only Plan 886 3Tier $15/$35/$50 Rx

Last Updated: Jan 10, 2024

Summary of Benefits and Coverage - Omnia EPO - 100/60 Plan 913 $10/$50/$75 Rx

Last Updated: Sep 25, 2023

Summary of Benefits and Coverage - Omnia HSA EPO - 80/50 Plan 929

Last Updated: Nov 15, 2023

Summary of Benefits and Coverage - Omnia EPO - 100/50 Plan 934

Last Updated: Sep 25, 2023

Summary of Benefits and Coverage - Omnia HSA EPO - 90/70 Plan 949

Last Updated: Oct 9, 2023

Summary of Benefits and Coverage - Omnia - EPO - 55/45 Plan 952 50% Rx

Last Updated: Jan 10, 2024

Summary of Benefits and Coverage - Omnia - EPO - 50% Plan 958 50% Rx

Last Updated: Jan 10, 2024

Summary of Benefits and Coverage - Omnia HSA EPO - 90/70 Plan 959

Last Updated: Oct 9, 2023

Summary of Benefits and Coverage - Omnia - EPO - 50% Plan 968 50% Rx

Last Updated: Jan 10, 2024