| Geisinger Gold |
H3954-157 |
Geisinger Gold Classic Advantage Rx (HMO) |
Y |
Varies |
Y |
$99.30 |
| Geisinger Gold |
H3954-158 |
Geisinger Gold Classic Complete Rx (HMO) |
Y |
$0.00 |
Y |
$48.00 |
| Geisinger Gold |
H3954-161 |
Geisinger Gold Classic Essential Rx (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| Geisinger Gold |
H3954-160 |
Geisinger Gold Classic 360 Rx (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| Geisinger Gold |
H3924-059 |
Geisinger Gold Preferred Advantage Rx (PPO) |
Y |
Varies |
Y |
Varies |
| Geisinger Gold |
H3924-065 |
Geisinger Gold Preferred Complete Rx (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Geisinger Gold |
H3954-163 |
Geisinger Gold Value Rx (HMO) |
Y |
$0.00 |
Y |
$23.00 |
| Geisinger Gold |
H3954-097 |
Geisinger Gold Secure Rx (HMO D-SNP) |
Y |
$0.00 |
Y |
$32.70 |
| UPMC for Life |
H3907-006 |
UPMC for Life HMO Rx Enhanced (HMO) |
Y |
$201.60 |
Y |
$93.40 |
| UPMC for Life |
H3907-037 |
UPMC for Life HMO Deductible Rx (HMO) |
Y |
$3.90 |
Y |
$18.10 |
| UPMC for Life |
H3907-057 |
UPMC for Life HMO Rx Choice (HMO) |
Y |
Varies |
Y |
Varies |
| UPMC for Life |
H3907-058 |
UPMC for Life HMO Rx (HMO) |
Y |
$56.30 |
Y |
$33.70 |
| UPMC for Life |
H3907-059 |
UPMC for Life HMO Premier Rx (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC for Life |
H3907-802 |
UPMC for Life |
Y |
Varies |
Y |
Varies |
| UPMC for Life |
H5533-003 |
UPMC for Life PPO High Deductible Rx (PPO) |
Y |
$0.00 |
Y |
$33.00 |
| UPMC for Life |
H5533-005 |
UPMC for Life PPO Rx Enhanced (PPO) |
Y |
$0.00 |
Y |
$140.00 |
| UPMC for Life |
H5533-008 |
UPMC for Life PPO Rx Enhanced (PPO) |
Y |
$15.30 |
Y |
$42.70 |
| UPMC for Life |
H5533-011 |
UPMC for Life PPO Premier Rx (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC for Life |
H5533-013 |
UPMC for Life PPO Premier Rx (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC for Life |
H5533-015 |
UPMC for Life PPO Rx Choice (PPO) |
Y |
$0.00 |
Y |
Varies |
| UPMC for Life |
H5533-017 |
UPMC for Life PPO Essential Care Rx (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC for Life |
H5533-802 |
UPMC for Life |
Y |
Varies |
Y |
Varies |
| UPMC for Life |
S3389-802 |
UPMC for Life |
N/A |
N/A |
Y |
Varies |
| Wellcare |
S4802-141 |
Wellcare Value Script (PDP) |
N/A |
N/A |
Y |
$8.20 |
| Wellcare |
S4802-080 |
Wellcare Classic (PDP) |
N/A |
N/A |
Y |
$14.70 |
| Capital Blue Cross |
H3962-001 |
Capital Blue Cross Premier (HMO) |
Y |
$60.70 |
Y |
$25.30 |
| Capital Blue Cross |
H3962-004 |
Capital Blue Cross Value (HMO) |
Y |
$24.10 |
Y |
$33.90 |
| Capital Blue Cross |
H3962-022 |
Capital Blue Cross Essential (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| Capital Blue Cross |
H3923-013 |
Capital Blue Cross Classic (PPO) |
Y |
$39.50 |
Y |
$32.50 |
| Capital Blue Cross |
H3923-017 |
Capital Blue Cross Prime (PPO) |
Y |
$99.70 |
Y |
$77.30 |
| Capital Blue Cross |
H3923-044 |
Capital Blue Cross Select (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Capital Blue Cross |
H3923-045 |
Capital Blue Cross Value (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Capital Blue Cross |
H3923-046 |
Capital Blue Cross Enhanced (PPO) |
Y |
$0.00 |
Y |
Varies |
| Capital Blue Cross |
H3923-047 |
Capital Blue Cross Complete (PPO) |
Y |
$0.00 |
Y |
Varies |
| Capital Blue Cross |
H3923-048 |
Capital Blue Cross Basic (PPO) |
Y |
$2.00 |
Y |
$18.00 |
| Humana |
H5525-005 |
HumanaChoice H5525-005 (PPO) |
N |
$0.00 |
Y |
$26.00 |
| Humana |
H5525-006 |
HumanaChoice H5525-006 (PPO) |
N |
$0.00 |
Y |
$27.00 |
| Humana |
H5525-051 |
HumanaChoice H5525-051 (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H5525-059 |
Humana USAA Honor Giveback with Rx (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H5525-085 |
HumanaChoice Giveback H5525-085 (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H5525-086 |
HumanaChoice H5525-086 (PPO) |
N |
$0.00 |
Y |
Varies |
| Humana |
H6622-035 |
Humana Gold Plus H6622-035 (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H6622-036 |
Humana Gold Plus H6622-036 (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H6622-037 |
Humana Gold Plus H6622-037 (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H6622-054 |
Humana Gold Plus H6622-054 (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H6622-078 |
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H7617-048 |
HumanaChoice SNP-DE H7617-048 (PPO D-SNP) |
N |
$0.00 |
Y |
$11.50 |
| Humana |
H5377-003 |
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) |
N |
$0.00 |
Y |
$2.60 |
| Humana |
H5216-023 |
HumanaChoice H5216-023 (PPO) |
N |
$0.00 |
Y |
$21.00 |
| Humana |
H5216-120 |
HumanaChoice H5216-120 (PPO) |
N |
$8.40 |
Y |
$85.60 |
| Humana |
H5216-227 |
HumanaChoice SNP-DE H5216-227 (PPO D-SNP) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
H8145-052 |
Humana Gold Choice H8145-052 (PFFS) |
N |
$0.00 |
Y |
$0.00 |
| Humana |
R0110-008 |
HumanaChoice R0110-008 (Regional PPO) |
N |
$0.00 |
Y |
$52.00 |
| Humana |
S5884-104 |
Humana Basic Rx Plan (PDP) |
N/A |
N/A |
Y |
$6.60 |
| Humana |
S5884-152 |
Humana Premier Rx Plan (PDP) |
N/A |
N/A |
Y |
$123.60 |
| Humana |
S5884-185 |
Humana Value Rx Plan (PDP) |
N/A |
N/A |
Y |
$19.40 |
| Aetna Medicare |
S5601-012 |
SilverScript Choice (PDP) |
N/A |
N/A |
Y |
$22.70 |
| Aetna Medicare |
H3931-004 |
Aetna Medicare Premier (HMO-POS) |
N |
$0.00 |
Y |
$104.00 |
| Aetna Medicare |
H3931-091 |
Aetna Medicare PinnacleHealth Prime (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H3959-001 |
Aetna Medicare Advantra Enhanced (HMO-POS) |
N |
$5.00 |
Y |
$19.00 |
| Aetna Medicare |
H3959-002 |
Aetna Medicare Advantra Premier (HMO-POS) |
N |
$0.00 |
Y |
$29.00 |
| Aetna Medicare |
H3959-010 |
Aetna Medicare Advantra Signature (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H3959-011 |
Aetna Medicare Advantra Signature Plus (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H3959-032 |
Aetna Medicare Advantra Signature Plus (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H3959-033 |
Aetna Medicare Value Care (HMO-POS) |
N |
$0.00 |
Y |
$32.70 |
| Aetna Medicare |
H3959-035 |
Aetna Medicare Advantra Dual Care (HMO D-SNP) |
N |
$0.00 |
Y |
$31.80 |
| Aetna Medicare |
H3959-036 |
Aetna Medicare Advantra Dual (HMO D-SNP) |
N |
$0.00 |
Y |
$13.80 |
| Aetna Medicare |
H3959-037 |
Aetna Medicare Advantra Signature (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H3959-039 |
Aetna Medicare Advantra Enhanced (HMO-POS) |
N |
$0.00 |
Y |
$48.00 |
| Aetna Medicare |
H3959-052 |
Aetna Medicare Advantra Signature (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H3959-053 |
Aetna Medicare Advantra Prime Plus (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H3959-066 |
Aetna Medicare Longevity (HMO I-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Aetna Medicare |
H3959-069 |
Aetna Community HealthChoices (HMO D-SNP) |
N |
$0.00 |
Y |
$14.70 |
| Aetna Medicare |
H3959-070 |
Aetna Community HealthChoices (HMO D-SNP) |
N |
$0.00 |
Y |
$21.70 |
| Aetna Medicare |
H3959-071 |
Aetna Community HealthChoices (HMO D-SNP) |
N |
$0.00 |
Y |
$16.10 |
| Aetna Medicare |
H3959-072 |
Aetna Community HealthChoices (HMO D-SNP) |
N |
$0.00 |
Y |
$14.20 |
| Aetna Medicare |
H3959-073 |
Aetna Community HealthChoices (HMO D-SNP) |
N |
$0.00 |
Y |
$14.40 |
| Aetna Medicare |
H3959-074 |
Aetna Medicare Chronic Care Value (HMO C-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Aetna Medicare |
H3959-075 |
Aetna Medicare Chronic Care Value (HMO C-SNP) |
N |
$0.00 |
Y |
$28.80 |
| Aetna Medicare |
H3959-076 |
Aetna Medicare Chronic Care (HMO C-SNP) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H3959-085 |
Aetna Medicare Chronic Care Value (HMO C-SNP) |
N |
$0.00 |
Y |
$29.70 |
| Aetna Medicare |
H5521-122 |
Aetna Medicare Enhanced (PPO) |
N |
$8.00 |
Y |
$175.00 |
| Aetna Medicare |
H5521-261 |
Aetna Medicare Signature (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H5521-263 |
Aetna Medicare Signature Extra (PPO) |
N |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
S5921-351 |
AARP Medicare Rx Saver from UHC (PDP) |
N/A |
N/A |
Y |
$43.50 |
| UnitedHealthcare |
S5921-388 |
AARP Medicare Rx Preferred from UHC (PDP) |
N/A |
N/A |
Y |
$121.90 |
| UnitedHealthcare |
H0710-017 |
UHC Nursing Home Plan EX-F002 (PPO I-SNP) |
Y |
$0.00 |
Y |
$32.60 |
| UnitedHealthcare |
H1889-007 |
UHC Dual Complete PA-S001 (PPO D-SNP) |
Y |
$0.00 |
Y |
$32.70 |
| UnitedHealthcare |
H2001-110 |
AARP Medicare Advantage from UHC PA-0015 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H2406-046 |
AARP Medicare Advantage from UHC PA-0007 (PPO) |
Y |
$0.00 |
Y |
$42.00 |
| UnitedHealthcare |
H2406-047 |
AARP Medicare Advantage from UHC PA-0008 (PPO) |
Y |
$0.00 |
Y |
$60.00 |
| UnitedHealthcare |
H2406-048 |
AARP Medicare Advantage from UHC PA-0009 (PPO) |
Y |
$0.00 |
Y |
$79.00 |
| UnitedHealthcare |
H2406-071 |
AARP Medicare Advantage from UHC PA-0010 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H2406-072 |
AARP Medicare Advantage from UHC PA-0011 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H2406-101 |
AARP Medicare Advantage Giveback from UHC PA-12 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H3113-009 |
UHC Dual Complete PA-S002 (HMO-POS D-SNP) |
Y |
$0.00 |
Y |
$6.80 |
| UnitedHealthcare |
H3113-014 |
UHC Dual Complete PA-V001 (HMO-POS D-SNP) |
Y |
$0.00 |
Y |
$30.40 |
| UnitedHealthcare |
H3113-016 |
UHC Dual Complete PA-S3 (HMO-POS D-SNP) |
Y |
$0.00 |
Y |
$18.50 |
| UnitedHealthcare |
H5253-145 |
AARP Medicare Advantage from UHC PA-0001 (HMO-POS) |
Y |
$0.00 |
Y |
$49.00 |
| UnitedHealthcare |
H5253-146 |
AARP Medicare Advantage from UHC PA-0002 (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H5253-147 |
AARP Medicare Advantage from UHC PA-0003 (HMO-POS) |
Y |
$0.00 |
Y |
$39.00 |
| UnitedHealthcare |
H5253-154 |
AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H5253-192 |
UHC Complete Care PA-17 (HMO-POS C-SNP) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H5253-203 |
AARP Medicare Advantage Extras from UHC PA-18 (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H5652-001 |
Erickson Advantage Signature (HMO-POS) |
Y |
$8.30 |
Y |
$173.70 |
| UnitedHealthcare |
H5652-003 |
Erickson Advantage Guardian (HMO-POS I-SNP) |
Y |
$0.00 |
Y |
$0.00 |
| UnitedHealthcare |
H5652-004 |
Erickson Advantage Champion (HMO-POS C-SNP) |
Y |
$62.50 |
Y |
$119.50 |
| UnitedHealthcare |
H5652-006 |
Erickson Advantage Freedom (HMO-POS) |
Y |
$0.00 |
Y |
$89.00 |
| UnitedHealthcare |
H5652-008 |
Erickson Advantage Liberty (HMO-POS) |
Y |
$0.00 |
Y |
$14.00 |
| Highmark Blue Cross Blue Shield |
H3916-001 |
Freedom Blue PPO Classic (PPO) |
Y |
$102.60 |
Y |
$145.40 |
| Highmark Blue Cross Blue Shield |
H3916-002 |
Freedom Blue PPO Classic (PPO) |
Y |
$79.10 |
Y |
$140.90 |
| Highmark Blue Cross Blue Shield |
H3916-005 |
Freedom Blue PPO Deluxe (PPO) |
Y |
$103.60 |
Y |
$122.40 |
| Highmark Blue Cross Blue Shield |
H3916-015 |
Freedom Blue PPO Standard (PPO) |
Y |
$22.80 |
Y |
$98.20 |
| Highmark Blue Cross Blue Shield |
H3916-018 |
Freedom Blue PPO ValueRx (PPO) |
Y |
$22.00 |
Y |
$44.00 |
| Highmark Blue Cross Blue Shield |
H3916-022 |
Freedom Blue PPO Select (PPO) |
Y |
$23.30 |
Y |
$115.70 |
| Highmark Blue Cross Blue Shield |
H3916-024 |
Freedom Blue PPO Select (PPO) |
Y |
$0.30 |
Y |
$95.70 |
| Highmark Blue Cross Blue Shield |
H3916-032 |
Freedom Blue PPO ValueRx (PPO) |
Y |
$2.00 |
Y |
$77.00 |
| Highmark Blue Cross Blue Shield |
H3916-033 |
Freedom Blue PPO ValueRx (PPO) |
Y |
$27.80 |
Y |
$37.20 |
| Highmark Blue Cross Blue Shield |
H3916-035 |
Complete Blue PPO Distinct (PPO) |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-037 |
Community Blue Medicare PPO Signature (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-038 |
Complete Blue PPO Signature (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-039 |
Community Blue Medicare Plus PPO Signature (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-041 |
Complete Blue PPO Signature (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-057 |
Complete Blue PPO Merit (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-058 |
Complete Blue PPO Signature (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-059 |
Complete Blue PPO Distinct (PPO) |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-060 |
Complete Blue PPO Distinct (PPO) |
Y |
$44.00 |
Y |
$11.00 |
| Highmark Blue Cross Blue Shield |
H3916-061 |
Complete Blue Plus PPO Distinct (PPO) |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-062 |
Complete Blue PPO Distinct (PPO) |
Y |
$109.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-063 |
Community Blue Medicare Plus PPO Signature (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-064 |
Complete Blue Plus PPO Merit (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-065 |
Community Blue Medicare PPO Signature (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-066 |
Complete Blue PPO Merit (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3916-802 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-804 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-806 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-807 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-808 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-809 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3916-810 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Shield |
S5593-002 |
Blue Rx PDP Plus (PDP) |
N/A |
N/A |
Y |
$193.20 |
| Highmark Blue Shield |
S5593-003 |
Blue Rx PDP Complete (PDP) |
N/A |
N/A |
Y |
$164.80 |
| Highmark Blue Shield |
S5593-801 |
Highmark Blue Shield |
N/A |
N/A |
Y |
Varies |
| Highmark Blue Shield |
S5593-802 |
Highmark Blue Shield |
N/A |
N/A |
Y |
Varies |
| Highmark Blue Shield |
S5593-807 |
Highmark Blue Shield |
N/A |
N/A |
Y |
Varies |
| Highmark Blue Shield |
S5593-808 |
Highmark Blue Shield |
N/A |
N/A |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-031 |
Security Blue HMO-POS ValueRx (HMO-POS) |
Y |
$25.00 |
Y |
$10.00 |
| Highmark Blue Cross Blue Shield |
H3957-042 |
Community Blue Medicare HMO Signature (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3957-044 |
Security Blue HMO-POS ValueRx (HMO-POS) |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-045 |
Security Blue HMO-POS Standard (HMO-POS) |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-046 |
Security Blue HMO-POS Deluxe (HMO-POS) |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-047 |
Community Blue Medicare HMO Signature (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3957-048 |
Together Blue Medicare HMO Signature (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3957-049 |
Community Blue Medicare HMO Distinct (HMO) |
Y |
$27.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3957-050 |
Complete Blue HMO Distinct (HMO) |
Y |
$20.00 |
Y |
$0.00 |
| Highmark Blue Cross Blue Shield |
H3957-806 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-808 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-811 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-812 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-814 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-815 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-816 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-817 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Highmark Blue Cross Blue Shield |
H3957-818 |
Highmark Blue Cross Blue Shield |
Y |
Varies |
Y |
Varies |
| Jefferson Health Plans |
H9207-002 |
Jefferson Health Plans Prime (HMO) |
N |
$0.00 |
Y |
$32.70 |
| Jefferson Health Plans |
H9207-004 |
Jefferson Health Plans Special (HMO D-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Jefferson Health Plans |
H9207-012 |
Jefferson Health Plans Complete (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Jefferson Health Plans |
H9207-015 |
Jefferson Health Plans Giveback (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Jefferson Health Plans |
H9207-016 |
Jefferson Health Plans Dual Pearl (HMO D-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Jefferson Health Plans |
H9207-017 |
Jefferson Health Plans Select (HMO D-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Highmark Wholecare Medicare Assured |
H5932-009 |
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) |
N |
$0.00 |
Y |
$17.60 |
| Highmark Wholecare Medicare Assured |
H5932-013 |
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) |
N |
$0.00 |
Y |
$13.10 |
| Devoted Health |
H6852-005 |
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) |
N |
$0.00 |
Y |
$22.50 |
| Devoted Health |
H6852-007 |
DEVOTED DUAL PLUS 007 PA (HMO D-SNP) |
N |
$0.00 |
Y |
$16.90 |
| Devoted Health |
H6852-008 |
DEVOTED CORE 008 PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6852-009 |
DEVOTED GIVEBACK 009 PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6852-010 |
DEVOTED CORE 010 PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6852-011 |
DEVOTED GIVEBACK 011 PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6852-012 |
DEVOTED CORE 012 PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6852-013 |
DEVOTED GIVEBACK 013 PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6852-014 |
DEVOTED CORE 014 PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6852-016 |
DEVOTED C-SNP PREMIUM 016 PA (HMO C-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Devoted Health |
H6852-017 |
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Devoted Health |
H6852-018 |
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Devoted Health |
H6852-019 |
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Devoted Health |
H6852-020 |
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Devoted Health |
H6852-021 |
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Devoted Health |
H6852-022 |
DEVOTED C-SNP PLUS 022 PA (HMO C-SNP) |
N |
$0.00 |
Y |
$32.70 |
| Devoted Health |
H6852-023 |
DEVOTED CORE 023 PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6852-025 |
DEVOTED DUAL FULL 025 PA (HMO D-SNP) |
N |
$0.00 |
Y |
$19.70 |
| Devoted Health |
H6852-026 |
DEVOTED DUAL FULL 026 PA (HMO D-SNP) |
N |
$0.00 |
Y |
$19.50 |
| Devoted Health |
H6018-002 |
DEVOTED CHOICE PREMIUM 002 PA (PPO) |
N |
$0.00 |
Y |
$32.70 |
| Devoted Health |
H6018-003 |
DEVOTED CHOICE GIVEBACK 003 PA (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6018-007 |
DEVOTED CHOICE 007 PA (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6018-008 |
DEVOTED CHOICE GIVEBACK 008 PA (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6018-010 |
DEVOTED CHOICE 010 PA (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Devoted Health |
H6018-011 |
DEVOTED CHOICE GIVEBACK 011 PA (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
S5617-215 |
HealthSpring Assurance Rx (PDP) |
N |
$0.00 |
Y |
$74.00 |
| Cigna HealthCare |
S5617-356 |
HealthSpring Extra Rx (PDP) |
N |
$0.00 |
Y |
$62.60 |
| Aetna Medicare |
H5522-001 |
Aetna Medicare Value Plus (PPO) |
N |
$0.00 |
Y |
$29.00 |
| Aetna Medicare |
H5522-002 |
Aetna Medicare Advantra Premier (PPO) |
N |
$1.00 |
Y |
$97.00 |
| Aetna Medicare |
H5522-004 |
Aetna Medicare Advantra Signature (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H5522-005 |
Aetna Medicare Value Plus (PPO) |
N |
$0.00 |
Y |
$13.00 |
| Aetna Medicare |
H5522-013 |
Aetna Medicare Value Care (PPO) |
N |
$0.00 |
Y |
$29.00 |
| Aetna Medicare |
H5522-014 |
Aetna Medicare Advantra Premier (PPO) |
N |
$1.00 |
Y |
$105.00 |
| Aetna Medicare |
H5522-017 |
Aetna Medicare Advantra Signature Giveback (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H5522-022 |
Aetna Medicare Signature Giveback (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H5522-028 |
Aetna Medicare Signature (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H5522-029 |
Aetna Medicare PinnacleHealth Prime (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Aetna Medicare |
H5522-032 |
Aetna Medicare Enhanced (PPO) |
N |
$0.00 |
Y |
$66.00 |
| Cigna HealthCare |
H3949-009 |
HealthSpring TotalCare Plus (HMO D-SNP) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
H3949-024 |
HealthSpring Achieve (HMO C-SNP) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
H3949-030 |
HealthSpring Preferred Plus (HMO) |
N |
$18.70 |
Y |
$12.30 |
| Cigna HealthCare |
H3949-031 |
HealthSpring Preferred PA (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
H3949-035 |
HealthSpring Preferred (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
H3949-045 |
HealthSpring Preferred (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
H3949-047 |
HealthSpring Preferred (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
H3949-048 |
HealthSpring Preferred Plus (HMO) |
N |
$9.70 |
Y |
$11.30 |
| Cigna HealthCare |
H3949-049 |
HealthSpring Preferred (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
H3949-052 |
HealthSpring Preferred (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Cigna HealthCare |
H3949-053 |
HealthSpring Preferred Savings (HMO) |
N |
$0.00 |
Y |
$0.00 |
| Jefferson Health Plans |
H1619-001 |
Jefferson Health Plans Flex (PPO) |
N |
$0.00 |
Y |
$0.00 |
| Jefferson Health Plans |
H1619-002 |
Jefferson Health Plans Flex Plus (PPO) |
N |
$0.00 |
Y |
$32.70 |
| Jefferson Health Plans |
H1619-003 |
Jefferson Health Plans Flex Pro (PPO) |
N |
$0.00 |
Y |
$18.00 |
| Independence Blue Cross |
H3909-001 |
Personal Choice 65 Rx (PPO) |
Y |
$124.80 |
Y |
$102.20 |
| Independence Blue Cross |
H3909-009 |
Personal Choice 65 Rx (PPO) |
Y |
$74.30 |
Y |
$112.70 |
| Independence Blue Cross |
H3909-018 |
Personal Choice 65 Plus Rx (PPO) |
Y |
$132.80 |
Y |
$81.20 |
| Independence Blue Cross |
H3909-802 |
Independence Blue Cross |
Y |
Varies |
Y |
Varies |
| Independence Blue Cross |
H6875-801 |
Independence Blue Cross |
Y |
Varies |
Y |
Varies |
| Independence Blue Cross |
H6875-802 |
Independence Blue Cross |
Y |
Varies |
Y |
Varies |
| Independence Blue Cross |
H3952-020 |
Keystone 65 Preferred Rx (HMO) |
Y |
$108.30 |
Y |
$79.70 |
| Independence Blue Cross |
H3952-045 |
Keystone 65 Preferred Rx (HMO) |
Y |
$98.30 |
Y |
$59.70 |
| Independence Blue Cross |
H3952-049 |
Keystone 65 Select Rx (HMO) |
Y |
$0.00 |
Y |
$47.00 |
| Independence Blue Cross |
H3952-051 |
Keystone 65 Select Rx (HMO) |
Y |
$10.50 |
Y |
$63.50 |
| Independence Blue Cross |
H3952-053 |
Keystone 65 Focus Rx (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| Independence Blue Cross |
H3952-054 |
Keystone 65 Focus Rx (HMO-POS) |
Y |
$15.00 |
Y |
$0.00 |
| Independence Blue Cross |
H3952-055 |
Keystone 65 Basic Rx (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| Independence Blue Cross |
H3952-060 |
Keystone 65 Essential Rx (HMO-POS) |
Y |
$0.00 |
Y |
$31.00 |
| Independence Blue Cross |
H3952-804 |
Independence Blue Cross |
Y |
Varies |
Y |
Varies |
