| GEISINGER HEALTH PLAN |
H3954-097 |
GEISINGER GOLD SECURE RX (HMO-SNP) |
Y |
$0.00 |
Y |
$48.40 |
| GEISINGER HEALTH PLAN |
H3954-157 |
GEISINGER GOLD CLASSIC ADVANTAGE RX (HMO) |
Y |
varies |
Y |
$45.70 |
| GEISINGER HEALTH PLAN |
H3954-158 |
GEISINGER GOLD CLASSIC COMPLETE RX (HMO) |
Y |
$0.00 |
Y |
$39.00 |
| GEISINGER HEALTH PLAN |
H3954-160 |
GEISINGER GOLD CLASSIC 360 RX (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| GEISINGER HEALTH PLAN |
H3954-161 |
GEISINGER GOLD CLASSIC ESSENTIAL RX (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| GEISINGER HEALTH PLAN |
H3954-163 |
GEISINGER GOLD VALUE RX (HMO) |
Y |
$0.00 |
Y |
$23.00 |
| GEISINGER HEALTH PLAN |
H3924-059 |
GEISINGER GOLD PREFERRED ADVANTAGE RX (PPO) |
Y |
varies |
Y |
$67.40 |
| GEISINGER HEALTH PLAN |
H3924-065 |
GEISINGER GOLD PREFERRED COMPLETE RX (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| GEISINGER HEALTH PLAN |
H3924-062 |
GEISINGER GOLD PREFERRED ENHANCED RX (PPO) |
Y |
varies |
Y |
varies |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-001 |
FREEDOM BLUE PPO CLASSIC (PPO) |
Y |
$133.40 |
Y |
$118.60 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-002 |
FREEDOM BLUE PPO CLASSIC (PPO) |
Y |
$103.00 |
Y |
$121.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-005 |
FREEDOM BLUE PPO DELUXE (PPO) |
Y |
$144.00 |
Y |
$104.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-015 |
FREEDOM BLUE PPO STANDARD (PPO) |
Y |
$41.70 |
Y |
$92.30 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-018 |
FREEDOM BLUE PPO VALUERX (PPO) |
Y |
$0.00 |
Y |
$39.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-022 |
FREEDOM BLUE PPO SELECT (PPO) |
Y |
$26.30 |
Y |
$112.70 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-024 |
FREEDOM BLUE PPO SELECT (PPO) |
Y |
$16.30 |
Y |
$79.70 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-032 |
FREEDOM BLUE PPO VALUERX (PPO) |
Y |
$0.00 |
Y |
$45.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-033 |
FREEDOM BLUE PPO VALUERX (PPO) |
Y |
$0.00 |
Y |
$42.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-034 |
COMMUNITY BLUE MEDICARE PPO Distinct (PPO) |
Y |
$4.40 |
Y |
$10.60 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-035 |
COMMUNITY BLUE PPO DISTINCT (PPO) |
Y |
$5.30 |
Y |
$6.70 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-036 |
COMMUNITY BLUE MEDICARE PLUS PPO DISTINCT (PPO) |
Y |
$5.10 |
Y |
$14.90 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-037 |
COMMUNITY BLUE MEDICARE PPO SIGNATURE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-038 |
COMMUNITY BLUE PPO SIGNATURE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-039 |
COMMUNITY BLUE MEDICARE PLUS PPO SIGNATURE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-041 |
COMPLETE BLUE PPO SIGNATURE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-044 |
COMPLETE BLUE PPO PREMIER (PPO) |
Y |
$19.70 |
Y |
$29.30 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-045 |
COMMUNITY BLUE MEDICARE PPO PREMIER (PPO) |
Y |
$19.60 |
Y |
$35.40 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-046 |
COMMUNITY BLUE MEDICARE PLUS PPO PREMIER (PPO) |
Y |
$19.70 |
Y |
$35.30 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-047 |
COMPLETE BLUE PPO CHOICE DELUXE (PPO) |
Y |
$1.70 |
Y |
$4.30 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-048 |
COMPLETE BLUE PPO CHOICE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-049 |
COMPLETE BLUE PPO MERIT (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-050 |
COMPLETE BLUE PPO CHOICE DELUXE (PPO) |
Y |
$2.70 |
Y |
$4.30 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-051 |
COMPLETE BLUE PLUS PPO CHOICE DELUXE (PPO) |
Y |
$2.70 |
Y |
$4.30 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-052 |
COMPLETE BLUE PPO CHOICE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-053 |
COMPLETE BLUE PLUS PPO CHOICE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-054 |
COMPLETE BLUE PLUS PPO CHOICE DELUXE (PPO) |
Y |
$4.70 |
Y |
$4.30 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-055 |
COMPLETE BLUE PPO PREMIER (PPO) |
Y |
$38.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-802 |
COMMUNITY BLUE MEDICARE PPO |
Y |
varies |
Y |
varies |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-804 |
COMMUNITY BLUE MEDICARE PLUS |
Y |
varies |
Y |
varies |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-806 |
COMMUNITY BLUE MEDICARE PPO |
Y |
varies |
Y |
varies |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-807 |
COMMUNITY BLUE MEDICARE PLUS |
Y |
varies |
Y |
varies |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-808 |
COMMUNITY BLUE MEDICARE PPO |
Y |
varies |
Y |
varies |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-809 |
COMMUNITY BLUE MEDICARE PLUS |
Y |
varies |
Y |
varies |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-810 |
COMMUNITY BLUE MEDICARE PLUS |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-031 |
SECURITY BLUE HMO-POS VALUERX (HMO-POS) |
Y |
$2.70 |
Y |
$27.30 |
| HIGHMARK CHOICE COMPANY |
H3957-039 |
COMMUNITY BLUE MEDICARE HMO PRESTIGE (HMO) |
Y |
$0.00 |
Y |
$35.00 |
| HIGHMARK CHOICE COMPANY |
H3957-042 |
COMMUNITY BLUE MEDICARE HMO SIGNATURE (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK CHOICE COMPANY |
H3957-044 |
SECURITY BLUE HMO-POS VALUE RX (HMO-POS) |
Y |
$2.70 |
Y |
$14.30 |
| HIGHMARK CHOICE COMPANY |
H3957-045 |
SECURITY BLUE HMO-POS STANDARD (HMO-POS) |
Y |
varies |
Y |
$67.00 |
| HIGHMARK CHOICE COMPANY |
H3957-046 |
SECURITY BLUE HMO-POS DELUXE (HMO-POS) |
Y |
varies |
Y |
$71.70 |
| HIGHMARK CHOICE COMPANY |
H3957-047 |
COMMUNITY BLUE MEDICARE HMO SIGNATURE (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK CHOICE COMPANY |
H3957-048 |
TOGETHER BLUE MEDICARE HMO SIGNATURE |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK CHOICE COMPANY |
H3957-806 |
COMMUNITY BLUE MEDICARE HMO PRESTIGE |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-808 |
SECURITY BLUE HMO-POS VALUE RX |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-811 |
SECURITY BLUE HMO-POS DELUXE |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-812 |
COMMUNITY BLUE MEDICARE HMO PRESTIGE |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-814 |
SECURITY BLUE HMO-POS VALUE RX |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-815 |
SECURITY BLUE HMO-POS DELUXE |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-816 |
SECURITY BLUE HMO-POS VALUE RX |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-817 |
SECURITY BLUE HMO-POS DELUXE |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-818 |
SECURITY BLUE HMO-POS DELUXE |
Y |
varies |
Y |
varies |
| HIGHMARK HEALTH INSURANCE COMPANY |
S5593-002 |
BLUE RX PDP PLUS (PDP) |
N/A |
N/A |
Y |
$143.20 |
| HIGHMARK HEALTH INSURANCE COMPANY |
S5593-003 |
BLUE RX PDP COMPLETE (PDP) |
N/A |
N/A |
Y |
$168.20 |
| HIGHMARK HEALTH INSURANCE COMPANY |
S5593-801 |
BLUE RX PDP PLUS (PDP) |
N/A |
N/A |
Y |
varies |
| HIGHMARK HEALTH INSURANCE COMPANY |
S5593-802 |
BLUE RX PDP PLUS (PDP) |
N/A |
N/A |
Y |
varies |
| HIGHMARK HEALTH INSURANCE COMPANY |
S5593-807 |
BLUE RX PDP COMPLETE (PDP) |
N/A |
N/A |
Y |
varies |
| HIGHMARK HEALTH INSURANCE COMPANY |
S5593-808 |
BLUE RX PDP PLUS (PDP) |
N/A |
N/A |
Y |
varies |
| UPMC HEALTH PLAN |
H3907-006 |
UPMC for Life HMO Rx Enhanced (HMO) |
Y |
$202.10 |
Y |
$92.90 |
| UPMC HEALTH PLAN |
H3907-037 |
UPMC for Life HMO Deductible Rx (HMO) |
Y |
$0.00 |
Y |
$22.00 |
| UPMC HEALTH PLAN |
H3907-057 |
UPMC for Life HMO Rx CHOICE (HMO) |
Y |
varies |
Y |
$16.20 |
| UPMC HEALTH PLAN |
H3907-058 |
UPMC for Life HMO Rx (HMO) |
Y |
varies |
Y |
$21.40 |
| UPMC HEALTH PLAN |
H3907-059 |
UPMC for Life HMO Premier Rx (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC HEALTH PLAN |
H3907-802 |
UPMC For Life Employer Group Rx (HMO) |
Y |
varies |
Y |
varies |
| UPMC HEALTH PLAN |
H5533-003 |
UPMC for Life PPO High Deductible Rx (PPO) |
Y |
$0.00 |
Y |
$33.00 |
| UPMC HEALTH PLAN |
H5533-005 |
UPMC for Life PPO Rx Enhanced (PPO) |
Y |
$48.50 |
Y |
$91.50 |
| UPMC HEALTH PLAN |
H5533-008 |
UPMC for Life PPO Rx Enhanced (PPO) |
Y |
$41.90 |
Y |
$16.10 |
| UPMC HEALTH PLAN |
H5533-011 |
UPMC for Life PPO PREMIER Rx (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC HEALTH PLAN |
H5533-013 |
UPMC for Life PPO PREMIER Rx (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC HEALTH PLAN |
H5533-015 |
UPMC for Life PPO Rx Choice (PPO) |
Y |
varies |
Y |
$13.90 |
| UPMC HEALTH PLAN |
H5533-017 |
UPMC for Life PPO Rx Choice (PPO) |
Y |
$0.00 |
Y |
$19.00 |
| UPMC HEALTH PLAN |
H5533-802 |
UPMC For Life Employer Group Rx (PPO) |
Y |
varies |
Y |
varies |
| UPMC HEALTH PLAN |
S3389-802 |
UPMC For Life Employer Group Rx (PPO) |
Y |
varies |
Y |
varies |
| AETNA HEALTH |
H3959-001 |
AETNA MEDICARE ADVANTRA GOLD (HMO) |
N |
$0.00 |
Y |
$19.00 |
| AETNA HEALTH |
H3959-002 |
AETNA MEDICARE ADVANTRA GOLD (HMO) |
N |
$0.00 |
Y |
$19.00 |
| AETNA HEALTH |
H3959-010 |
AETNA MEDICARE ADVANTRA SILVER (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-011 |
AETNA MEDICARE ADVANTRA SILVER (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-032 |
AETNA MEDICARE ADVANTRA PREMIER (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-033 |
AETNA MEDICARE VALUE PLUS (HMO-POS) |
N |
$0.00 |
Y |
$29.00 |
| AETNA HEALTH |
H3959-035 |
AETNA MEDICARE ADVANTRA CARES (HMO D-SNP) |
N |
$0.00 |
Y |
$36.20 |
| AETNA HEALTH |
H3959-036 |
AETNA MEDICARE ADVANTRA CARES (HMO D-SNP) |
N |
$0.00 |
Y |
$26.20 |
| AETNA HEALTH |
H3959-037 |
AETNA MEDICARE ADVANTRA GOLD (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-039 |
AETNA MEDICARE ADVANTRA PREMIER (HMO-POS) |
N |
$0.00 |
Y |
$18.00 |
| AETNA HEALTH |
H3959-052 |
AETNA MEDICARE ADVANTRA Value (HMO) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-053 |
AETNA MEDICARE ADVANTRA Philly Prime (HMO) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-066 |
AETNA MEDICARE LONGEVITY Plan (HMO I-SNP) |
N |
$0.00 |
Y |
$48.40 |
| AETNA HEALTH |
H3959-069 |
AETNA MEDICARE COMMUNITY COMPLETE (HMO D-SNP) |
N |
$0.00 |
Y |
$30.10 |
| AETNA HEALTH |
H3959-070 |
AETNA MEDICARE COMMUNITY COMPLETE (HMO D-SNP) |
N |
$0.00 |
Y |
$36.80 |
| AETNA HEALTH |
H3959-071 |
AETNA MEDICARE COMMUNITY COMPLETE (HMO D-SNP) |
N |
$0.00 |
Y |
$31.00 |
| AETNA HEALTH |
H3959-072 |
AETNA MEDICARE COMMUNITY COMPLETE (HMO D-SNP) |
N |
$0.00 |
Y |
$29.00 |
| AETNA HEALTH |
H3959-073 |
AETNA MEDICARE COMMUNITY COMPLETE (HMO D-SNP) |
N |
$0.00 |
Y |
$30.20 |
| AETNA HEALTH |
H3959-074 |
AETNA MEDICARE PRIME CHRONIC CARE (HMO C-SNP) |
N |
$0.00 |
Y |
$48.40 |
| AETNA HEALTH |
H3959-075 |
AETNA MEDICARE CHRONIC CARE VALUE (HMO C-SNP) |
N |
$0.00 |
Y |
$48.40 |
| AETNA HEALTH |
H3959-076 |
AETNA MEDICARE CHRONIC CARE (HMO C-SNP) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-077 |
AETNA MEDICARE PRIME CHRONIC CARE (HMO C-SNP) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3931-004 |
AETNA MEDICARE PREMIER PLUS (HMO-POS) |
N |
$16.90 |
Y |
$72.10 |
| AETNA HEALTH |
H3931-064 |
AETNA MEDICARE PREMIER (HMO-POS) |
N |
$0.00 |
Y |
$61.00 |
| AETNA HEALTH |
H3931-091 |
AETNA MEDICARE PinnacleHealth Prime (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H5521-122 |
AETNA MEDICARE GOLD PLAN (PPO) |
N |
$30.70 |
Y |
$111.30 |
| AETNA HEALTH |
H5521-261 |
AETNA MEDICARE VALUE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H5521-263 |
AETNA MEDICARE VALUE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-001 |
AETNA MEDICARE VALUE Plus (PPO) |
N |
$0.00 |
Y |
$28.00 |
| HEALTH ASSURANCE |
H5522-002 |
AETNA MEDICARE ADVANTRA Premier Plus (PPO) |
N |
$15.60 |
Y |
$56.40 |
| HEALTH ASSURANCE |
H5522-004 |
AETNA MEDICARE ADVANTRA Silver (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-005 |
AETNA MEDICARE VALUE Plus (PPO) |
N |
$0.00 |
Y |
$13.00 |
| HEALTH ASSURANCE |
H5522-013 |
AETNA MEDICARE VALUE Plus (PPO) |
N |
$0.00 |
Y |
$19.00 |
| HEALTH ASSURANCE |
H5522-014 |
AETNA MEDICARE ADVANTRA Premier Plus (PPO) |
N |
$7.00 |
Y |
$65.00 |
| HEALTH ASSURANCE |
H5522-017 |
AETNA MEDICARE ADVANTRA Credit Value (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-022 |
AETNA MEDICARE SILVER BACK (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-024 |
AETNA MEDICARE DUAL PREFERRED (PPO D-SNP) |
N |
$0.00 |
Y |
$29.50 |
| HEALTH ASSURANCE |
H5522-028 |
AETNA MEDICARE FREEDOM CORE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-029 |
AETNA MEDICARE PINNACLE HEALTH PRIME (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-032 |
AETNA MEDICARE PINNACLE HEALTH PRIME (PPO) |
N |
$0.00 |
Y |
$32.00 |
| WELLCARE PRESCRIPTION INSURANCE |
S4802-080 |
WELLCARE CLASSIC (PDP) |
N/A |
N/A |
Y |
$20.30 |
| WELLCARE PRESCRIPTION INSURANCE |
S4802-141 |
WELLCARE VALUE SCRIPT |
N/A |
N/A |
Y |
$0.00 |
| WELLCARE PRESCRIPTION INSURANCE |
S4802-209 |
WELLCARE MEDICARE RX VALUE PLUS |
N/A |
N/A |
Y |
$107.40 |
| SILVERSCRIPT INSURANCE |
S5601-012 |
SILVERSCRIPT CHOICE (PDP) |
N/A |
N/A |
Y |
$44.90 |
| UNITED HEALTHCARE |
S5921-351 |
AARP MedicareRx Saver Plus |
N/A |
N/A |
Y |
$64.00 |
| UNITED HEALTHCARE |
S5921-388 |
AARP MedicareRx Walgreens |
N/A |
N/A |
Y |
$103.50 |
| UNITED HEALTHCARE |
H0710-017 |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) |
Y |
$0.00 |
Y |
$48.20 |
| UNITED HEALTHCARE |
H1889-007 |
UnitedHealthcare Dual Complete Choice (PPO D-SNP) |
Y |
$0.00 |
Y |
$31.50 |
| UNITED HEALTHCARE |
H2001-105 |
AARP Medicare Advantage from UHC PA-0014 (PPO) |
Y |
$0.00 |
Y |
$31.00 |
| UNITED HEALTHCARE |
H2001-110 |
AARP Medicare Advantage from UHC PA-0015 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2406-046 |
AARP Medicare Advantage from UHC PA-0007 (PPO) |
Y |
$0.00 |
Y |
$35.00 |
| UNITED HEALTHCARE |
H2406-047 |
AARP Medicare Advantage from UHC PA-0008 (PPO) |
Y |
$0.20 |
Y |
$63.80 |
| UNITED HEALTHCARE |
H2406-048 |
AARP Medicare Advantage from UHC PA-0007 (PPO) |
Y |
$0.00 |
Y |
$59.00 |
| UNITED HEALTHCARE |
H2406-071 |
AARP Medicare Advantage from UHC PA-0008 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2406-072 |
AARP Medicare Advantage from UHC PA-0011 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2406-101 |
AARP Medicare Advantage from UHC PA-0012 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2406-102 |
AARP Medicare Advantage from UHC PA-0012 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H3113-009 |
UnitedHealthcare Dual Complete PA-S002 (HMO-POS D-SNP) |
Y |
$0.00 |
Y |
$27.00 |
| UNITED HEALTHCARE |
H3113-014 |
UnitedHealthcare Dual Complete PA-V001 (HMO-POS D-SNP) |
Y |
$0.00 |
Y |
$46.80 |
| UNITED HEALTHCARE |
H3113-016 |
UnitedHealthcare Dual Complete PA-V001 (HMO-POS D-SNP) |
Y |
$0.00 |
Y |
$48.40 |
| UNITED HEALTHCARE |
H5253-145 |
AARP Medicare Advantage from UHC PA-0001 (HMO-POS) |
Y |
$7.70 |
Y |
$28.30 |
| UNITED HEALTHCARE |
H5253-146 |
AARP Medicare Advantage from UHC PA-0002 (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H5253-147 |
AARP Medicare Advantage from UHC PA-0003 (HMO-POS) |
Y |
$26.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H5253-154 |
AARP Medicare Advantage from UHC PA-0005 (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H5253-192 |
UHC Complete Care PA-17 (HMO-POS C-SNP) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H5652-001 |
Erickson Advantage Signature with Drugs (HMO-POS) |
Y |
$118.60 |
Y |
$43.40 |
| UNITED HEALTHCARE |
H5652-003 |
Erickson Advantage Guardian (HMO-POS I-SNP) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H5652-004 |
Erickson Advantage Champion (HMO-POS C-SNP) |
Y |
$145.20 |
Y |
$21.80 |
| UNITED HEALTHCARE |
H5652-006 |
Erickson Advantage Freedom (HMO-POS) |
Y |
$0.00 |
Y |
$67.00 |
| UNITED HEALTHCARE |
H5652-008 |
Erickson Advantage Liberty with Drugs (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3962-001 |
BlueJourney Premier (HMO) |
Y |
$47.20 |
Y |
$36.80 |
| CAPITAL BLUE CROSS |
H3962-004 |
BLUEJOURNEY VALUE |
Y |
$18.30 |
Y |
$34.70 |
| CAPITAL BLUE CROSS |
H3962-007 |
BLUEJOURNEY ESSENTIAL (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3962-021 |
WELLSPAN HEALTH INSPIRE (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3923-013 |
BLUEJOURNEY CLASSIC (PPO) |
Y |
$33.50 |
Y |
$32.50 |
| CAPITAL BLUE CROSS |
H3923-017 |
BLUEJOURNEY PRIME (PPO) |
Y |
$106.70 |
Y |
$61.30 |
| CAPITAL BLUE CROSS |
H3923-028 |
CAPITAL BLUE CROSS SELECT (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3923-029 |
WELLSPAN HEALTH ADVANTAGE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3923-030 |
WELLSPAN HEALTH ADVANTAGE PLUS (PPO) |
Y |
$11.70 |
Y |
$14.30 |
| CAPITAL BLUE CROSS |
H3923-031 |
WELLSPAN HEALTH VALUE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3923-032 |
CAPITAL BLUE CROSS VALUE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3923-033 |
CAPITAL BLUE CROSS VALUE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3923-034 |
CAPITAL BLUE CROSS ENHANCED (PPO) |
Y |
$0.00 |
Y |
$27.00 |
| CAPITAL BLUE CROSS |
H3923-035 |
CAPITAL BLUE CROSS ENHANCED (PPO) |
Y |
$10.30 |
Y |
$15.70 |
| CAPITAL BLUE CROSS |
H3923-038 |
CAPITAL BLUE CROSS VALUE (PPO) |
Y |
$14.70 |
Y |
$28.30 |
| CAPITAL BLUE CROSS |
H3923-039 |
Capital Blue Cross Complete (PPO) |
Y |
$15.10 |
Y |
$27.90 |
| CAPITAL BLUE CROSS |
H3923-040 |
CAPITAL BLUE CROSS ENHANCED (PPO) |
Y |
$28.40 |
Y |
$14.60 |
| HUMANA |
H5216-227 |
HumanaChoice SNP-DE H5216-227 (PPO D-SNP) |
N |
$0.00 |
Y |
$29.90 |
| HUMANA |
H5216-117 |
Humana Value Plus H5216-117 (PPO) |
N |
$0.00 |
Y |
$28.70 |
| HUMANA |
H5216-120 |
HumanaChoice H5216-120 (PPO) |
N |
$45.20 |
Y |
$59.80 |
| HUMANA |
S5884-104 |
Humana Basic Rx Plan (PDP) |
N/A |
N/A |
Y |
$70.60 |
| HUMANA |
S5884-152 |
Humana Premier Rx Plan (PDP) |
N/A |
N/A |
Y |
$128.90 |
| HUMANA |
S5884-185 |
Humana Walmart Value Rx Plan (PDP) |
N/A |
N/A |
Y |
$39.80 |
| HUMANA |
H5525-005 |
HumanaChoice H5525-005 (PPO) |
N |
$0.10 |
Y |
$40.90 |
| HUMANA |
H5525-006 |
HumanaChoice H5525-006 (PPO) |
N |
$0.00 |
Y |
$38.00 |
| HUMANA |
H5525-017 |
HumanaChoice H5525-017 (PPO) |
N |
$0.00 |
y |
$26.00 |
| 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 |
| HEALTH PARTNERS PLANS |
H9207-002 |
Jefferson Health Plans Prime (HMO) |
N |
$0.00 |
Y |
$40.90 |
| HEALTH PARTNERS PLANS |
H9207-004 |
Jefferson Health Plans Special (HMO D-SNP) |
N |
$0.00 |
Y |
$48.40 |
| HEALTH PARTNERS PLANS |
H9207-012 |
Jefferson Health Plans Complete (HMO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH PARTNERS PLANS |
H9207-015 |
Jefferson Health Plans Giveback (HMO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH PARTNERS PLANS |
H9207-016 |
Jefferson Health Plans Dual Pearl (HMO D-SNP) |
N |
$0.00 |
Y |
$48.40 |
| HEALTH PARTNERS PLANS |
H1619-001 |
Jefferson Health Plans Flex (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH PARTNERS PLANS |
H1619-002 |
Jefferson Health Plans Flex Plus (PPO) |
N |
$0.00 |
Y |
$37.00 |
| QCC INSURANCE COMPANY |
H3909-001 |
PERSONAL CHOICE 65 RX (PPO) |
Y |
$130.80 |
Y |
$61.20 |
| QCC INSURANCE COMPANY |
H3909-009 |
PERSONAL CHOICE 65 RX (PPO) |
Y |
$91.90 |
Y |
$60.10 |
| QCC INSURANCE COMPANY |
H3909-015 |
PERSONAL CHOICE 65 PRIME RX (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| QCC INSURANCE COMPANY |
H3909-016 |
PERSONAL CHOICE 65 SAVOR RX (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| QCC INSURANCE COMPANY |
H3909-017 |
PERSONAL CHOICE 65 ELITE RX (PPO) |
Y |
$0.00 |
Y |
$16.60 |
| QCC INSURANCE COMPANY |
H3909-018 |
PERSONAL CHOICE 65 ELITE RX (PPO) |
Y |
$95.30 |
Y |
$68.70 |
| QCC INSURANCE COMPANY |
H6875-801 |
SELECT OPTION RX GROUP OPTION I |
Y |
varies |
Y |
varies |
| QCC INSURANCE COMPANY |
H6875-802 |
SELECT OPTION RX GROUP OPTION I |
Y |
varies |
Y |
varies |
| KEYSTONE HEALTH PLAN |
H3952-020 |
KEYSTONE 65 PREFERRED RX (HMO) |
Y |
$114.80 |
Y |
$58.20 |
| KEYSTONE HEALTH PLAN |
H3952-045 |
KEYSTONE 65 PREFERRED RX (HMO) |
Y |
$127.60 |
Y |
$15.40 |
| KEYSTONE HEALTH PLAN |
H3952-049 |
KEYSTONE 65 SELECT RX (HMO) |
Y |
$32.40 |
Y |
$9.60 |
| KEYSTONE HEALTH PLAN |
H3952-051 |
KEYSTONE 65 SELECT RX (HMO) |
Y |
$69.00 |
Y |
$0.00 |
| KEYSTONE HEALTH PLAN |
H3952-053 |
KEYSTONE 65 FOCUS RX (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| KEYSTONE HEALTH PLAN |
H3952-054 |
KEYSTONE 65 FOCUS RX (HMO-POS) |
Y |
$10.00 |
Y |
$0.00 |
| KEYSTONE HEALTH PLAN |
H3952-055 |
KEYSTONE 65 BASIC RX (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| KEYSTONE HEALTH PLAN |
H3952-060 |
Keystone 65 Essential Rx (HMO-POS) |
Y |
$0.00 |
Y |
$2.10 |
| KEYSTONE HEALTH PLAN |
H3952-804 |
KEYSTONE 65 GROUP RX (HMO) |
Y |
varies |
Y |
varies |
| CIGNA/MEDCO |
S5617-215 |
Cigna Healthcare Assurance Rx (PDP) |
N/A |
N/A |
Y |
$64.40 |
| CIGNA/MEDCO |
S5617-356 |
Cigna Healthcare Saver Rx (PDP) |
N/A |
N/A |
Y |
$12.60 |
| CIGNA/MEDCO |
S5617-251 |
Cigna Healthcare Extra Rx (PDP) |
N/A |
N/A |
Y |
$95.30 |
