| 77552OH0010204 |
Bronze 7500 $25 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020204 |
Bronze 7500 $25 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010212 |
Core Gold 1500 $10 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020212 |
Core Gold 1500 $10 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010210 |
Diabetes Gold 3000 $0 Chronic Care Drugs & Services |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020210 |
Diabetes Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010209 |
Diabetes Silver 5000 $0 Chronic Care Drugs & Services |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020209 |
Diabetes Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010202 |
Gold 2000 $15 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020202 |
Gold 2000 $15 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010219 |
HDHP Preventive Silver 5500 $0 Chronic Care Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010215 |
Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020215 |
Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010218 |
Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020218 |
Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010222 |
Low Premium Bronze 10600 $25 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020222 |
Low Premium Bronze 10600 $25 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010201 |
Low Premium Silver 6200 $3 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020201 |
Low Premium Silver 6200 $3 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010203 |
Silver 6000 $20 Generic Drugs |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0020203 |
Silver 6000 $20 Generic Drugs + Adult Vision & Fitness |
2026 |
PREFERRED
|
Oct 15, 2025 |
| 77552OH0010204 |
Bronze First 7500 $25 Generic Drugs |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020204 |
Bronze First 7500 $25 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010212 |
Core Gold 1500 $10 Generic Drugs |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020212 |
Core Gold 1500 $10 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010210 |
Diabetes Gold 1100 $0 Select Drugs & Specialized Services |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020210 |
Diabetes Gold 1100 $0 Select Drugs & Specialized Services Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010209 |
Diabetes Silver 4000 $0 Select Drugs & Specialized Services |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020209 |
Diabetes Silver 4000 $0 Select Drugs & Specialized Services Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010202 |
Gold 1500 $15 Generic Drugs |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020202 |
Gold 1500 $15 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010219 |
HDHP Preventive Silver 5500 $0 Select Drugs |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010215 |
Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020215 |
Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010218 |
Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020218 |
Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010201 |
Low Premium Silver 6000 $3 Generic Drugs |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020201 |
Low Premium Silver 6000 $3 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0010203 |
Silver 5000 $20 Generic Drugs |
2025 |
PREFERRED
|
Oct 09, 2024 |
| 77552OH0020203 |
Silver 5000 $20 Generic Drugs Adult Vision & Fitness |
2025 |
PREFERRED
|
Oct 09, 2024 |