| 54192IN0010015 |
Bronze 7500 $25 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020015 |
Bronze 7500 $25 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010026 |
Diabetes Gold 3000 $0 Chronic Care Drugs & Services |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020026 |
Diabetes Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010025 |
Diabetes Silver 5000 $0 Chronic Care Drugs & Services |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020025 |
Diabetes Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010012 |
Gold 2000 $15 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020012 |
Gold 2000 $15 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010033 |
HDHP Preventive Silver 5500 $0 Chronic Care Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010030 |
Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020030 |
Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010032 |
Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020032 |
Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010010 |
HSA Eligible Bronze 6000 |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010020 |
Low Premium Bronze 10600 $25 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020020 |
Low Premium Bronze 10600 $25 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010011 |
Low Premium Silver 6200 $3 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020011 |
Low Premium Silver 6200 $3 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010029 |
Platinum Zero $5 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020029 |
Platinum Zero $5 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010014 |
Silver 6000 $20 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0020014 |
Silver 6000 $20 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 54192IN0010015 |
Bronze First 7500 $25 Generic Drugs |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020015 |
Bronze First 7500 $25 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010026 |
Diabetes Gold 1100 $0 Select Drugs & Specialized Services |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020026 |
Diabetes Gold 1100 $0 Select Drugs & Specialized Services Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010025 |
Diabetes Silver 4000 $0 Select Drugs & Specialized Services |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020025 |
Diabetes Silver 4000 $0 Select Drugs & Specialized Services Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010012 |
Gold 1500 $15 Generic Drugs |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020012 |
Gold 1500 $15 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010033 |
HDHP Preventive Silver 5500 $0 Select Drugs |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010030 |
Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020030 |
Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010032 |
Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020032 |
Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010010 |
HSA Eligible Bronze 6000 |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010020 |
Low Premium Bronze 9200 $25 Generic Drugs |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020020 |
Low Premium Bronze 9200 $25 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010011 |
Low Premium Silver 6000 $3 Generic Drugs |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020011 |
Low Premium Silver 6000 $3 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010029 |
Platinum Zero $5 Generic Drugs |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020029 |
Platinum Zero $5 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0010014 |
Silver 5000 $20 Generic Drugs |
2025 |
PREFERRED
|
Sep 13, 2024 |
| 54192IN0020014 |
Silver 5000 $20 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Sep 13, 2024 |