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PARENT NAME CONTRACT/PBP PRODUCT NAME Part C Agreement PART C PREM Part D Agreement PART D PREM
GEISINGER HEALTH PLAN H3954-097 GEISINGER GOLD SECURE RX (HMO-SNP) Y $0.00 Y $40.20
GEISINGER HEALTH PLAN H3954-157 GEISINGER GOLD CLASSIC ADVANTAGE RX (HMO) Y $84.40 Y $44.60
GEISINGER HEALTH PLAN H3954-158 GEISINGER GOLD CLASSIC COMPLETE RX (HMO) Y $0.00 Y $34.00
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 $27.10 Y $51.90
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 $19.20 Y $44.80
HIGHMARK SENIOR HEALTH COMPANY H3916-001 FREEDOM BLUE PPO CLASSIC (PPO) Y $169.00 Y $102.00
HIGHMARK SENIOR HEALTH COMPANY H3916-002 FREEDOM BLUE PPO CLASSIC (PPO) Y $140.10 Y $102.90
HIGHMARK SENIOR HEALTH COMPANY H3916-005 FREEDOM BLUE PPO DELUXE (PPO) Y $179.00 Y $99.00
HIGHMARK SENIOR HEALTH COMPANY H3916-015 FREEDOM BLUE PPO STANDARD (PPO) Y $83.20 Y $80.80
HIGHMARK SENIOR HEALTH COMPANY H3916-018 FREEDOM BLUE PPO VALUERX (PPO) Y $0.00 Y $58.00
HIGHMARK SENIOR HEALTH COMPANY H3916-022 FREEDOM BLUE PPO SELECT (PPO) Y $60.80 Y $97.20
HIGHMARK SENIOR HEALTH COMPANY H3916-024 FREEDOM BLUE PPO SELECT (PPO) Y $46.90 Y $72.10
HIGHMARK SENIOR HEALTH COMPANY H3916-032 FREEDOM BLUE PPO VALUERX (PPO) Y $8.00 Y $56.00
HIGHMARK SENIOR HEALTH COMPANY H3916-033 FREEDOM BLUE PPO VALUERX (PPO) Y $0.00 Y $61.00
HIGHMARK SENIOR HEALTH COMPANY H3916-034 COMMUNITY BLUE MEDICARE Y $0.00 Y $27.00
HIGHMARK SENIOR HEALTH COMPANY H3916-035 COMMUNITY BLUE PPO DISTINCT Y $0.00 Y $27.00
HIGHMARK SENIOR HEALTH COMPANY H3916-036 COMMUNITY BLUE MEDICARE PLUS Y $0.00 Y $27.00
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 PPO SIGNATURE Y $0.00 Y $0.00
HIGHMARK SENIOR HEALTH COMPANY H3916-044 COMPLETE BLUE PPO PREMIER Y $0.00 Y $46.00
HIGHMARK SENIOR HEALTH COMPANY H3916-046 COMMUNITY BLUE MEDICARE PLUS Y $0.00 Y $46.00
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 VALUERX (HMO) Y $0.00 Y $48.00
HIGHMARK CHOICE COMPANY H3957-039 COMMUNITY BLUE MEDICARE HMO PRESTIGE Y $0.00 Y $41.00
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 $43.00
HIGHMARK CHOICE COMPANY H3957-045 SECURITY BLUE HMO-POS STANDARD Y $94.70 Y $87.30
HIGHMARK CHOICE COMPANY H3957-046 SECURITY BLUE HMO-POS DELUXE Y $151.80 Y $93.20
HIGHMARK CHOICE COMPANY H3957-047 COMMUNITY BLUE MEDICARE HMO SIGNATURE 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 $108.80
HIGHMARK HEALTH INSURANCE COMPANY S5593-003 BLUE RX PDP COMPLETE (PDP) N/A N/A Y $195.10
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 $218.20 Y $76.80
UPMC HEALTH PLAN H3907-029 UPMC for Life HMO Rx (HMO) Y $57.00 Y $24.00
UPMC HEALTH PLAN H3907-037 UPMC for Life HMO Deductible Rx (HMO) Y $0.00 Y $20.80
UPMC HEALTH PLAN H3907-046 UPMC for Life HMO Premier Rx (HMO) Y $0.00 Y $0.00
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 H3907-057 UPMC for Life HMO Premier Rx (HMO) Y $19.50 Y $16.50
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 $29.50
UPMC HEALTH PLAN H5533-005 UPMC for Life PPO Rx Enhanced (PPO) Y $91.00 Y $43.00
UPMC HEALTH PLAN H5533-008 UPMC for Life PPO Rx Enhanced (PPO) Y $32.90 Y $25.10
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 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 $0.00 Y $19.00
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 $0.00 Y $22.60
AETNA HEALTH H3959-002 AETNA MEDICARE ADVANTRA GOLD (HMO) N $1.00 Y $18.00
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 $27.00
AETNA HEALTH H3959-035 AETNA MEDICARE ADVANTRA CARES (HMO D-SNP) N $0.00 Y $40.20
AETNA HEALTH H3959-036 AETNA MEDICARE ADVANTRA CARES (HMO D-SNP) N $0.00 Y $38.30
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 $21.00
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 $39.00
AETNA HEALTH H3931-004 AETNA MEDICARE PREMIER PLUS (HMO-POS) N $51.80 Y $35.20
AETNA HEALTH H3931-064 AETNA MEDICARE PREMIER (HMO-POS) N $21.30 Y $35.70
AETNA HEALTH H3931-070 AETNA MEDICARE SILVER (HMO) N $2.70 Y $34.30
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 $88.50 Y $56.50
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 VALUE Plus (PPO) N $0.00 Y $29.00
HEALTH ASSURANCE H5522-002 AETNA MEDICARE ADVANTRA Premier Plus (PPO) N $54.40 Y $12.60
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 $14.60
HEALTH ASSURANCE H5522-014 AETNA MEDICARE ADVANTRA Premier Plus (PPO) N $39.70 Y $19.30
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 H5522-023 AETNA MEDICARE DELUXE PLAN (PPO) N $0.00 Y $0.00
HEALTH ASSURANCE H5522-024 AETNA MEDICARE DUAL PREFERRED (PPO D-SNP) N $0.00 Y $35.40
HEALTH ASSURANCE H5522-025 AETNA MEDICARE SMARTSAVER ELITE N $0.00 Y $0.00
HEALTH ASSURANCE H5522-026 AETNA MEDICARE ESSENTIALS PLAN (PPO) N $0.00 Y $0.00
HEALTH ASSURANCE H5522-027 AETNA MEDICARE ESSENTIALS PLAN (PPO) N $0.00 Y $0.00
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
WELLCARE PRESCRIPTION INSURANCE S4802-080 WELLCARE CLASSIC (PDP) N/A N/A Y $40.16
WELLCARE PRESCRIPTION INSURANCE S4802-141 WELLCARE VALUE SCRIPT N/A N/A Y $0.50
WELLCARE PRESCRIPTION INSURANCE S4802-209 WELLCARE MEDICARE RX VALUE PLUS N/A N/A Y $78.90
SILVERSCRIPT INSURANCE S5601-012 SILVERSCRIPT CHOICE (PDP) N/A N/A Y $40.16
UNITED HEALTHCARE S5820-005 AARP MedicareRx Preferred N/A N/A Y $107.10
UNITED HEALTHCARE S5921-351 AARP MedicareRx Saver Plus N/A N/A Y $38.60
UNITED HEALTHCARE S5921-388 AARP MedicareRx Walgreens N/A N/A Y $68.50
UNITED HEALTHCARE H0710-017 UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP) Y $0.00 Y $32.20
UNITED HEALTHCARE H1889-007 UnitedHealthcare Dual Complete Choice (PPO D-SNP) Y $0.00 Y $40.20
UNITED HEALTHCARE H1944-010 AARP Medicare Advantage from UHC PA-0002 (HMO-POS) Y $0.00 Y $0.00
UNITED HEALTHCARE H1944-011 AARP Medicare Advantage from UHC PA-0003 (HMO-POS) Y $0.00 Y $39.00
UNITED HEALTHCARE H1944-024 AARP Medicare Advantage from UHC PA-0004 (HMO-POS) Y $0.00 Y $0.00
UNITED HEALTHCARE H1944-035 AARP Medicare Advantage from UHC PA-0006 (HMO-POS) Y $0.00 Y $0.00
UNITED HEALTHCARE H2406-046 AARP Medicare Advantage from UHC PA-0007 (PPO) Y $0.00 Y $25.00
UNITED HEALTHCARE H2406-047 AARP Medicare Advantage from UHC PA-0008 (PPO) Y $10.70 Y $33.30
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 H2406-117 AARP Medicare Advantage from UHC PA-0017 (PPO) Y $0.00 Y $0.00
UNITED HEALTHCARE H2577-021 AARP Medicare Advantage from UHC PA-0014 (PPO) Y $0.00 Y $40.00
UNITED HEALTHCARE H3113-009 UnitedHealthcare Dual Complete PA-S002 (HMO-POS D-SNP) Y $0.00 Y $33.90
UNITED HEALTHCARE H3113-014 UnitedHealthcare Dual Complete PA-V001 (HMO-POS D-SNP) Y $0.00 Y $29.50
UNITED HEALTHCARE H5652-001 Erickson Advantage Signature with Drugs (HMO-POS) Y $113.60 Y $54.40
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 $150.80 Y $37.20
UNITED HEALTHCARE H5652-006 Erickson Advantage Freedom (HMO-POS) Y $4.70 Y $59.30
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 $72.80 Y $44.20
CAPITAL BLUE CROSS H3962-004 BLUEJOURNEY VALUE Y $19.70 Y $45.30
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 $18.20 Y $41.80
CAPITAL BLUE CROSS H3923-017 BLUEJOURNEY PRIME (PPO) Y $127.30 Y $49.70
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 $10.60 Y $11.40
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 $22.00
CAPITAL BLUE CROSS H3923-035 CAPITAL BLUE CROSS ENHANCED (PPO) Y $0.00 Y $22.00
GATEWAY HEALTH PLANS H5932-001 HIGHMARK WHOLECARE MEDICARE ASSSURED DIAMOND (HMO D-SNP) N $0.00 Y $40.20
GATEWAY HEALTH PLANS H5932-009 HIGHMARK WHOLECARE MEDICARE ASSSURED RUBY (HMO D-SNP) N $0.00 Y $40.20
GATEWAY HEALTH PLANS H5932-012 HIGHMARK WHOLECARE MEDICARE ASSSURED DIAMOND (HMO D-SNP) N $0.00 Y $40.20
GATEWAY HEALTH PLANS H5932-013 HIGHMARK WHOLECARE MEDICARE ASSSURED RUBY (HMO D-SNP) N $0.00 Y $38.80
HUMANA H5216-227 Humana Choice (PPO) N $0.00 Y $40.20
HUMANA H5216-373 Humana Choice (PPO) N $0.00 Y $40.20
HUMANA H5216-117 Humana Value Plus (PPO) N $0.00 Y $40.20
HUMANA H5216-120 Humana Choice (PPO) N $69.70 Y $53.30
HUMANA R0923-002 Humana Choice (Regional PPO) N $5.00 Y $41.00
HUMANA S5884-104 Humana Basic Rx Plan (PDP) N/A N/A Y $45.30
HUMANA S5884-152 Humana Premier Rx Plan (PDP) N/A N/A Y $106.70
HUMANA S5884-185 Humana Walmart Value Rx Plan (PDP) N/A N/A Y $41.60
HUMANA H5525-005 Humana Choice (PPO) N $3.40 Y $49.60
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 H7849-104 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
HEALTH PARTNERS PLANS H9207-002 HEALTH PARTNERS MEDICARE PRIME (HMO-POS) N $0.00 Y $40.20
HEALTH PARTNERS PLANS H9207-004 HEALTH PARTNERS MEDICARE SPECIAL (HMO D-SNP) N $0.00 Y $40.20
HEALTH PARTNERS PLANS H9207-012 HEALTH PARTNERS MEDICARE COMPLETE (HMO-POS) N $0.00 Y $0.00
HEALTH PARTNERS PLANS H9207-015 HEALTH PARTNERS MEDICARE COMPLETE (HMO-POS) N $0.00 Y $0.00
HEALTH PARTNERS PLANS H9207-016 HEALTH PARTNERS MEDICARE COMPLETE (HMO-POS) N $0.00 Y $40.20
HEALTH PARTNERS PLANS H1619-001 HEALTH PARTNERS MEDICARE COMPLETE (HMO-POS) N $0.00 Y $0.00
HEALTH PARTNERS PLANS H1619-002 HEALTH PARTNERS MEDICARE COMPLETE (HMO-POS) N $0.00 Y $49.00
QCC INSURANCE COMPANY H3909-001 PERSONAL CHOICE 65 RX (PPO) Y $138.70 Y $108.30
QCC INSURANCE COMPANY H3909-009 PERSONAL CHOICE 65 RX (PPO) Y $112.30 Y $45.70
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 $0.00 Y $25.60
QCC INSURANCE COMPANY H3909-802 PERSONAL CHOICE 65 GROUP RX (PPO) Y varies Y varies
QCC INSURANCE COMPANY H6875-801 SELECT OPTION RX GROUP OPTION I Y varies Y varies
KEYSTONE HEALTH PLAN H3952-020 KEYSTONE 65 PREFERRED RX (HMO) Y $135.40 Y $43.60
KEYSTONE HEALTH PLAN H3952-045 KEYSTONE 65 PREFERRED RX (HMO) Y $153.60 Y $51.40
KEYSTONE HEALTH PLAN H3952-049 KEYSTONE 65 SELECT RX (HMO) Y $23.80 Y $26.70
KEYSTONE HEALTH PLAN H3952-051 KEYSTONE 65 SELECT RX (HMO) Y $57.60 Y $19.90
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 $15.00 Y $0.00
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
CIGNA HEALTH & LIFE INSURANCE H3949-009 Cigna TotalCare Plus (HMO D-SNP) N $0.00 Y $38.40
CIGNA HEALTH & LIFE INSURANCE H3949-024 Cigna Achieve Medicare (HMO C-SNP) N $0.00 Y $0.00
CIGNA HEALTH & LIFE INSURANCE H3949-030 Cigna Preferred Plus Medicare (HMO) N $0.00 Y $31.00
CIGNA HEALTH & LIFE INSURANCE H3949-031 Cigna Preferred Medicare (HMO) N $0.00 Y $0.00
CIGNA HEALTH & LIFE INSURANCE H3949-035 Cigna Preferred Medicare (HMO) N $0.00 Y $0.00
CIGNA HEALTH & LIFE INSURANCE H3949-045 Cigna Preferred Medicare (HMO) N $0.00 Y $0.00
CIGNA HEALTH & LIFE INSURANCE H3949-046 Cigna Preferred Plus Medicare (HMO) N $0.00 Y $28.00
CIGNA HEALTH & LIFE INSURANCE H3949-047 Cigna Preferred Medicare (HMO) N $0.00 Y $0.00
CIGNA HEALTH & LIFE INSURANCE H3949-048 Cigna Preferred Plus Medicare (HMO) N $0.00 Y $20.00
CIGNA HEALTH & LIFE INSURANCE H3949-049 Cigna Preferred Medicare (HMO) N $0.00 Y $0.00
CIGNA HEALTH & LIFE INSURANCE H3949-050 Cigna Preferred Plus Medicare (HMO) N $0.00 Y $24.00