| GEISINGER HEALTH PLAN |
H3954-097 |
GEISINGER GOLD SECURE RX (HMO-SNP) |
Y |
$0.00 |
Y |
$41.10 |
| GEISINGER HEALTH PLAN |
H3954-157 |
GEISINGER GOLD CLASSIC ADVANTAGE RX (HMO) |
Y |
$92.90 |
Y |
$62.10 |
| GEISINGER HEALTH PLAN |
H3954-158 |
GEISINGER GOLD CLASSIC COMPLETE RX (HMO) |
Y |
$0.00 |
Y |
$38.00 |
| GEISINGER HEALTH PLAN |
H3954-161 |
GEISINGER GOLD CLASSIC ESSENTIAL RX (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| GEISINGER HEALTH PLAN |
H3954-160 |
GEISINGER GOLD CLASSIC 360 RX (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| GEISINGER HEALTH PLAN |
H3924-059 |
GEISINGER GOLD PREFERRED ADVANTAGE RX (PPO) |
Y |
$42.30 |
Y |
$66.70 |
| 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 |
$0.00 |
Y |
$45.00 |
| GEISINGER HEALTH PLAN |
H3924-066 |
GEISINGER GOLD PREFERRED 360 RX (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-001 |
FREEDOM BLUE PPO CLASSIC (PPO) |
Y |
$164.50 |
Y |
$113.50 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-002 |
FREEDOM BLUE PPO CLASSIC (PPO) |
Y |
$98.40 |
Y |
$121.60 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-005 |
FREEDOM BLUE PPO DELUXE (PPO) |
Y |
$158.50 |
Y |
$126.50 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-015 |
FREEDOM BLUE PPO STANDARD (PPO) |
Y |
$74.50 |
Y |
$96.50 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-018 |
FREEDOM BLUE PPO VALUERX (PPO) |
Y |
$0.00 |
Y |
$66.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-022 |
FREEDOM BLUE PPO SELECT (PPO) |
Y |
$57.90 |
Y |
$108.10 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-024 |
FREEDOM BLUE PPO SELECT (PPO) |
Y |
$21.20 |
Y |
$105.80 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-032 |
FREEDOM BLUE PPO VALUERX (PPO) |
Y |
$0.00 |
Y |
$71.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-033 |
FREEDOM BLUE PPO VALUERX (PPO) |
Y |
$0.00 |
Y |
$68.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-034 |
COMMUNITY BLUE MEDICARE |
Y |
$0.00 |
Y |
$25.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-035 |
COMMUNITY BLUE PPO DISTINCT |
Y |
$0.00 |
Y |
$25.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-036 |
COMMUNITY BLUE MEDICARE PLUS |
Y |
$0.00 |
Y |
$25.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-037 |
COMMUNITY BLUE MEDICARE PPO |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-038 |
COMMUNITY BLUE MEDICARE PPO |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-039 |
COMMUNITY BLUE MEDICARE PLUS |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-041 |
COMMUNITY BLUE MEDICARE PLUS |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-802 |
COMMUNITY BLUE MEDICARE PPO |
Y |
varies |
Y |
varies |
| HIGHMARK SENIOR HEALTH COMPANY |
H3916-806 |
COMMUNITY BLUE MEDICARE PLUS |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-031 |
SECURITY BLUE HMO VALUERX (HMO) |
Y |
$0.00 |
Y |
$59.00 |
| HIGHMARK CHOICE COMPANY |
H3957-039 |
COMMUNITY BLUE MEDICARE HMO PRESTIGE |
Y |
$0.00 |
Y |
$50.00 |
| HIGHMARK CHOICE COMPANY |
H3957-042 |
COMMUNITY BLUE MEDICARE HMO SIGNATURE |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK CHOICE COMPANY |
H3957-044 |
SECURITY BLUE HMO-POS VALUE RX |
Y |
$0.00 |
Y |
$54.00 |
| HIGHMARK CHOICE COMPANY |
H3957-045 |
SECURITY BLUE HMO-POS STANDARD |
Y |
$83.30 |
Y |
$109.70 |
| HIGHMARK CHOICE COMPANY |
H3957-046 |
SECURITY BLUE HMO-POS DELUXE |
Y |
$134.40 |
Y |
$121.60 |
| HIGHMARK CHOICE COMPANY |
H3957-047 |
COMMUNITY BLUE MEDICARE HMO SIGNATURE |
Y |
$0.00 |
Y |
$0.00 |
| HIGHMARK CHOICE COMPANY |
H3957-048 |
COMMUNITY 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 |
H3957-811 |
SECURITY BLUE HMO-POS VALUE RX |
Y |
varies |
Y |
varies |
| HIGHMARK CHOICE COMPANY |
H3957-814 |
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 |
$121.10 |
| HIGHMARK HEALTH INSURANCE COMPANY |
S5593-003 |
BLUE RX PDP COMPLETE (PDP) |
N/A |
N/A |
Y |
$192.60 |
| HIGHMARK HEALTH INSURANCE COMPANY |
S5593-801 |
BLUE RX PDP PLUS (PDP) |
N/A |
N/A |
Y |
varies |
| UPMC HEALTH PLAN |
H3907-006 |
UPMC for Life HMO Rx Enhanced (HMO) |
Y |
$192.50 |
Y |
$102.50 |
| UPMC HEALTH PLAN |
H3907-029 |
UPMC for Life HMO Rx (HMO) |
Y |
$31.50 |
Y |
$49.50 |
| UPMC HEALTH PLAN |
H3907-037 |
UPMC for Life HMO Deductible Rx (HMO) |
Y |
$0.00 |
Y |
$22.00 |
| UPMC HEALTH PLAN |
H3907-046 |
UPMC for Life HMO Premier Rx (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC HEALTH PLAN |
H3907-049 |
UPMC for Life HMO Rx Choice (HMO) |
Y |
$0.00 |
Y |
$36.00 |
| UPMC HEALTH PLAN |
H3907-050 |
UPMC for Life HMO Premier Rx (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC HEALTH PLAN |
H3907-052 |
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 |
$59.30 |
Y |
$74.70 |
| UPMC HEALTH PLAN |
H5533-008 |
UPMC for Life PPO Rx Enhanced (PPO) |
Y |
$3.00 |
Y |
$55.00 |
| UPMC HEALTH PLAN |
H5533-009 |
UPMC for Life PPO Rx Choice (PPO) |
Y |
$0.00 |
Y |
$23.00 |
| UPMC HEALTH PLAN |
H5533-011 |
UPMC for Life PPO Flex Rx (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC HEALTH PLAN |
H5533-013 |
UPMC for Life PPO Flex Rx (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UPMC HEALTH PLAN |
H5533-014 |
UPMC for Life PPO Flex Rx (PPO) |
Y |
$0.00 |
Y |
$23.00 |
| UPMC HEALTH PLAN |
H5533-802 |
UPMC For Life Employer Group Rx (PPO) |
Y |
varies |
Y |
varies |
| AETNA HEALTH |
H3959-001 |
AETNA MEDICARE ADVANTRA GOLD (HMO) |
N |
$9.10 |
Y |
$25.90 |
| AETNA HEALTH |
H3959-002 |
AETNA MEDICARE ADVANTRA GOLD (HMO) |
N |
$10.80 |
Y |
$24.20 |
| 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 ADVANTRA PREMIER (HMO) |
N |
$5.40 |
Y |
$21.60 |
| AETNA HEALTH |
H3959-035 |
AETNA MEDICARE ADVANTRA CARES (HMO D-SNP) |
N |
$0.00 |
Y |
$32.70 |
| AETNA HEALTH |
H3959-036 |
AETNA MEDICARE ADVANTRA CARES (HMO D-SNP) |
N |
$0.00 |
Y |
$24.60 |
| 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 |
$11.80 |
Y |
$11.20 |
| AETNA HEALTH |
H3959-045 |
AETNA MEDICARE PENNHIGHLANDS PRIME (HMO) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-046 |
AETNA MEDICARE ADVANTRA Washington Prime (HMO) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-047 |
AETNA MEDICARE ADVANTRA BUTLER Prime (HMO) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-049 |
AETNA MEDICARE ADVANTRA EXCELA Prime (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3959-051 |
AETNA MEDICARE BEAVER VALLEY PRIME (HMO) |
N |
$0.00 |
Y |
$0.00 |
| 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 |
$41.00 |
| AETNA HEALTH |
H3931-004 |
AETNA MEDICARE PREMIER PLUS (HMO-POS) |
N |
$61.90 |
Y |
$35.10 |
| AETNA HEALTH |
H3931-064 |
AETNA MEDICARE PREMIER (HMO-POS) |
N |
$25.70 |
Y |
$41.30 |
| AETNA HEALTH |
H3931-070 |
AETNA MEDICARE SILVER (HMO) |
N |
$16.50 |
Y |
$30.50 |
| AETNA HEALTH |
H3931-091 |
AETNA MEDICARE PinnacleHealth Prime (HMO) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H3931-105 |
AETNA MEDICARE Philly Suburban Value (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| AETNA HEALTH |
H5521-122 |
AETNA MEDICARE GOLD PLAN (PPO) |
N |
$117.60 |
Y |
$58.40 |
| 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 |
| AETNA HEALTH |
H5521-294 |
AETNA MEDICARE THE VALLEY PLAN (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-001 |
AETNA MEDICARE ADVANTRA Premier Plus (PPO) |
N |
$0.00 |
Y |
$33.00 |
| HEALTH ASSURANCE |
H5522-002 |
AETNA MEDICARE ADVANTRA Premier Plus (PPO) |
N |
$60.20 |
Y |
$16.80 |
| HEALTH ASSURANCE |
H5522-004 |
AETNA MEDICARE ADVANTRA Silver (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-005 |
AETNA MEDICARE ADVANTRA Silver (PPO) |
N |
$3.80 |
Y |
$13.20 |
| HEALTH ASSURANCE |
H5522-013 |
AETNA MEDICARE ADVANTRA Silver Plus (PPO) |
N |
$12.00 |
Y |
$6.00 |
| HEALTH ASSURANCE |
H5522-014 |
AETNA MEDICARE ADVANTRA Premier Plus (PPO) |
N |
$23.50 |
Y |
$24.50 |
| HEALTH ASSURANCE |
H5522-017 |
AETNA MEDICARE ADVANTRA Credit Value (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-020 |
AETNA MEDICARE ADVANTRA CENTRAL VALUE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| HEALTH ASSURANCE |
H5522-021 |
AETNA MEDICARE VALUE PLUS (PPO) |
N |
$17.40 |
Y |
$27.60 |
| HEALTH ASSURANCE |
H5522-022 |
AETNA MEDICARE SILVER BACK (PPO) |
N |
$0.00 |
Y |
$0.00 |
| WELLCARE PRESCRIPTION INSURANCE |
S4802-080 |
WELLCARE CLASSIC (PDP) |
N/A |
N/A |
Y |
$37.60 |
| WELLCARE PRESCRIPTION INSURANCE |
S4802-141 |
WELLCARE VALUE SCRIPT |
N/A |
N/A |
Y |
$11.10 |
| WELLCARE PRESCRIPTION INSURANCE |
S4802-209 |
WELLCARE MEDICARE RX VALUE PLUS |
N/A |
N/A |
Y |
$71.40 |
| SILVERSCRIPT INSURANCE |
S5601-012 |
SILVERSCRIPT CHOICE (PDP) |
N/A |
N/A |
Y |
$39.60 |
| CIGNA |
S5617-215 |
CIGNA SECURE |
N/A |
N/A |
Y |
$38.30 |
| CIGNA |
S5617-356 |
CIGNA SAVER |
N/A |
N/A |
Y |
$12.40 |
| CIGNA |
S5617-251 |
CIGNA EXTRA |
N/A |
N/A |
Y |
$57.80 |
| ELIXIR INSURANCE COMPANY |
S7694-006 |
ELIXIR RXSECURE |
N/A |
N/A |
Y |
$33.30 |
| ELIXIR INSURANCE COMPANY |
S7694-126 |
ELIXIR RXPLUS |
N/A |
N/A |
Y |
$60.10 |
| UNITED HEALTHCARE |
S5820-005 |
AARP MedicareRx Preferred |
N/A |
N/A |
Y |
$112.20 |
| UNITED HEALTHCARE |
S5921-351 |
AARP MedicareRx Saver Plus |
N/A |
N/A |
Y |
$37.00 |
| UNITED HEALTHCARE |
S5921-388 |
AARP MedicareRx Walgreens |
N/A |
N/A |
Y |
$32.60 |
| UNITED HEALTHCARE |
H0710-017 |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) |
Y |
$0.00 |
Y |
$41.00 |
| UNITED HEALTHCARE |
H0710-067 |
UnitedHealthcare Assisted Living Plan (PPO I-SNP) |
Y |
$0.00 |
Y |
$41.10 |
| UNITED HEALTHCARE |
H1889-007 |
UnitedHealthcare Dual Complete Choice (PPO D-SNP) |
Y |
$0.00 |
Y |
$41.10 |
| UNITED HEALTHCARE |
H1944-009 |
AARP Medicare Advantage Plan 2 (HMO-POS) |
Y |
$0.00 |
Y |
$27.00 |
| UNITED HEALTHCARE |
H1944-010 |
AARP Medicare Advantage Flex Plan 1 (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H1944-011 |
AARP Medicare Advantage Flex Plan 2 (HMO-POS) |
Y |
$0.00 |
Y |
$33.00 |
| UNITED HEALTHCARE |
H1944-024 |
AARP Medicare Advantage Flex (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H1944-033 |
AARP Medicare Advantage Plan 1 (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H1944-035 |
AARP Medicare Advantage Flex (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2228-035 |
AARP Medicare Advantage Choice Plan 1 (PPO) |
Y |
$0.00 |
Y |
$21.00 |
| UNITED HEALTHCARE |
H2228-036 |
AARP Medicare Advantage Choice Plan 2 (PPO) |
Y |
$2.70 |
Y |
$41.30 |
| UNITED HEALTHCARE |
H2228-037 |
AARP Medicare Advantage Choice Plan 1 (PPO) |
Y |
$2.00 |
Y |
$41.00 |
| UNITED HEALTHCARE |
H2228-085 |
AARP Medicare Advantage Choice Plan 2 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2228-086 |
AARP Medicare Advantage Choice Plan 3 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2228-130 |
AARP Medicare Advantage Choice Rebate (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2228-131 |
AARP Medicare Advantage Choice Plan 3 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2577-021 |
AARP Medicare Advantage Choice Plan 1 (PPO) |
Y |
$0.00 |
Y |
$35.00 |
| UNITED HEALTHCARE |
H2577-028 |
AARP Medicare Advantage Choice (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H2577-029 |
AARP Medicare Advantage Choice Plan 2 (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| UNITED HEALTHCARE |
H3113-009 |
UnitedHealthcare Dual Complete (HMO-POS D-SNP) |
Y |
$0.00 |
Y |
$33.90 |
| UNITED HEALTHCARE |
H3113-014 |
UnitedHealthcare Dual Complete Select (HMO-POS D-SNP) |
Y |
$0.00 |
Y |
$38.10 |
| UNITED HEALTHCARE |
H5652-001 |
Erickson Advantage Signature with Drugs (HMO-POS) |
Y |
$143.50 |
Y |
$53.50 |
| 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 |
$168.20 |
Y |
$28.20 |
| UNITED HEALTHCARE |
H5652-006 |
Erickson Advantage Freedom (HMO-POS) |
Y |
$12.10 |
Y |
$55.90 |
| UNITED HEALTHCARE |
H5652-008 |
Erickson Advantage Liberty with Drugs (HMO-POS) |
Y |
$0.00 |
Y |
$0.00 |
| HUMANA |
H5525-005 |
Humana Choice (PPO) |
N |
$15.60 |
Y |
$42.40 |
| HUMANA |
H5216-051 |
Humana Choice (PPO) |
N |
$0.00 |
Y |
$43.00 |
| HUMANA |
H5216-117 |
Humana Value Plus (PPO) |
N |
$0.00 |
Y |
$41.10 |
| HUMANA |
H5216-120 |
Humana Choice (PPO) |
N |
$76.90 |
Y |
$46.10 |
| HUMANA |
R0923-002 |
Humana Choice (Regional PPO) |
N |
$28.30 |
Y |
$42.70 |
| HUMANA |
S5884-104 |
Humana Basic Rx Plan (PDP) |
N/A |
N/A |
Y |
$42.00 |
| HUMANA |
S5884-152 |
Humana Premier Rx Plan (PDP) |
N/A |
N/A |
Y |
$88.40 |
| CAPITAL BLUE CROSS |
H3962-001 |
BlueJourney Premier (HMO) |
Y |
$59.50 |
Y |
$55.50 |
| CAPITAL BLUE CROSS |
H3962-004 |
BLUEJOURNEY VALUE |
Y |
$6.50 |
Y |
$52.50 |
| 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 |
$7.40 |
Y |
$43.60 |
| CAPITAL BLUE CROSS |
H3923-017 |
BLUEJOURNEY PRIME (PPO) |
Y |
$100.90 |
Y |
$73.10 |
| 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 |
$0.00 |
Y |
$19.00 |
| 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 |
$20.00 |
| CAPITAL BLUE CROSS |
H3923-035 |
CAPITAL BLUE CROSS ENHANCED (PPO) |
Y |
$0.00 |
Y |
$20.00 |
| CAPITAL BLUE CROSS |
H3923-036 |
CAPITAL BLUE CROSS VALUE (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| CAPITAL BLUE CROSS |
H3923-037 |
CAPITAL BLUE CROSS ENHANCED (PPO) |
Y |
$0.00 |
Y |
$20.00 |
| CAPITAL BLUE CROSS |
S8067-001 |
SECURERX - OPTION 3 (PDP) |
N/A |
N/A |
Y |
$78.10 |
| CAPITAL BLUE CROSS |
S8067-003 |
SECURERX - OPTION 1 (PDP) |
N/A |
N/A |
Y |
$126.30 |
| HEALTH PARTNERS PLANS |
H9207-002 |
HEALTH PARTNERS MEDICARE PRIME (HMO-POS) |
N |
$0.00 |
Y |
$41.10 |
| HEALTH PARTNERS PLANS |
H9207-004 |
HEALTH PARTNERS MEDICARE SPECIAL (HMO D-SNP) |
N |
$0.00 |
Y |
$41.10 |
| HEALTH PARTNERS PLANS |
H9207-012 |
HEALTH PARTNERS MEDICARE COMPLETE (HMO-POS) |
N |
$0.00 |
Y |
$0.00 |
| GATEWAY HEALTH PLANS |
H5932-009 |
HIGHMARK WHOLECARE MEDICARE ASSSURED RUBY (HMO D-SNP) |
N |
$0.00 |
Y |
$41.10 |
| GATEWAY HEALTH PLANS |
H5932-013 |
HIGHMARK WHOLECARE MEDICARE ASSSURED RUBY (HMO D-SNP) |
N |
$0.00 |
Y |
$41.10 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-009 |
CIGNA TOTALCARE PLUS (HMO D-SNP) |
N |
$0.00 |
Y |
$24.70 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-013 |
CIGNA PREFERRED PLUS MEDICARE (HMO) |
N |
$82.90 |
Y |
$35.10 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-024 |
CIGNA ACHIEVE MEDICARE (HMO -SNP) |
N |
$0.00 |
Y |
$0.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-030 |
CIGNA PREFERRED MEDICARE (HMO) |
N |
$0.00 |
Y |
$31.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-031 |
CIGNA ALLIANCE MEDICARE (HMO) |
N |
$0.00 |
Y |
$0.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-035 |
CIGNA PREFERRED MEDICARE (HMO) |
N |
$0.00 |
Y |
$0.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-045 |
CIGNA PREFERRED MEDICARE (HMO) |
N |
$0.00 |
Y |
$0.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-046 |
CIGNA PREFERRED PLUS MEDICARE (HMO) |
N |
$0.00 |
Y |
$28.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-047 |
CIGNA PREFERRED MEDICARE (HMO) |
N |
$0.00 |
Y |
$0.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-048 |
CIGNA PREFERRED PLUS MEDICARE (HMO) |
N |
$0.00 |
Y |
$26.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-049 |
CIGNA PREFERRED MEDICARE (HMO) |
N |
$0.00 |
Y |
$0.00 |
| BRAVO HEALTH PENNSYLVANIA |
H3949-050 |
CIGNA PREFERRED PLUS MEDICARE (HMO) |
N |
$0.00 |
Y |
$24.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-006 |
CIGNA TRUE CHOICE MEDICARE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-031 |
CIGNA TRUE CHOICE SAVINGS MEDICARE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-032 |
CIGNA TRUE CHOICE PLUS MEDICARE (PPO) |
N |
$0.00 |
Y |
$28.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-104 |
CIGNA TRUE CHOICE MEDICARE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-105 |
CIGNA TRUE CHOICE PLUS MEDICARE (PPO) |
N |
$0.00 |
Y |
$27.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-106 |
CIGNA TRUE CHOICE MEDICARE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-107 |
CIGNA TRUE CHOICE PLUS MEDICARE (PPO) |
N |
$0.00 |
Y |
$27.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-108 |
CIGNA TRUE CHOICE SAVINGS MEDICARE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-109 |
CIGNA TRUE CHOICE PLUS MEDICARE (PPO) |
N |
$0.00 |
Y |
$26.00 |
| CIGNA HEALTH & LIFE INSURANCE |
H7849-111 |
CIGNA TRUE CHOICE SAVINGS MEDICARE (PPO) |
N |
$0.00 |
Y |
$0.00 |
| QCC INSURANCE COMPANY |
H3909-001 |
PERSONAL CHOICE 65 RX (PPO) |
Y |
$162.60 |
Y |
$114.40 |
| QCC INSURANCE COMPANY |
H3909-009 |
PERSONAL CHOICE 65 RX (PPO) |
Y |
$100.30 |
Y |
$62.70 |
| QCC INSURANCE COMPANY |
H3909-014 |
PERSONAL CHOICE 65 PRIME RX (PPO) |
Y |
$0.00 |
Y |
$0.00 |
| 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 |
$7.10 |
Y |
$41.90 |
| QCC INSURANCE COMPANY |
H3909-802 |
PERSONAL CHOICE 65 GROUP RX (PPO) |
Y |
varies |
Y |
varies |
| QCC INSURANCE COMPANY |
S6875-801 |
SELECT OPTION RX GROUP OPTION I |
Y |
varies |
Y |
varies |
| KEYSTONE HEALTH PLAN |
H3952-020 |
KEYSTONE 65 PREFERRED RX (HMO) |
Y |
$111.10 |
Y |
$102.90 |
| KEYSTONE HEALTH PLAN |
H3952-045 |
KEYSTONE 65 PREFERRED RX (HMO) |
Y |
$150.40 |
Y |
$90.60 |
| KEYSTONE HEALTH PLAN |
H3952-049 |
KEYSTONE 65 SELECT RX (HMO) |
Y |
$0.00 |
Y |
$55.50 |
| KEYSTONE HEALTH PLAN |
H3952-051 |
KEYSTONE 65 SELECT RX (HMO) |
Y |
$19.70 |
Y |
$61.80 |
| 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 |
$0.00 |
Y |
$15.00 |
| KEYSTONE HEALTH PLAN |
H3952-055 |
KEYSTONE 65 BASIC RX (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| KEYSTONE HEALTH PLAN |
H3952-056 |
KEYSTONE 65 BASIC RX (HMO) |
Y |
$0.00 |
Y |
$0.00 |
| KEYSTONE HEALTH PLAN |
H3952-804 |
KEYSTONE 65 GROUP RX (HMO) |
Y |
varies |
Y |
varies |
