Grandfathered Plan Documents 2027
Pharmacy
| DOCUMENTS | DOWNLOAD/ACCESS |
|---|---|
3 & 4 Tier Standard Plans | |
Coinsurance & Brand-Generic Standard Plans |
Summary of Benefits and Coverage (SBC)
The Summary of Benefits and Coverage (SBC) provides a concise description of what services your plan covers along with what you will pay for covered benefits.
| Plans | Download |
|---|---|
BluePreferred 100 1500 | |
BluePreferred 100 2500 | |
BluePreferred 100 5000 | |
BluePreferred 90 100 | |
BluePreferred 90 250 | |
BluePreferred 90 500 | |
BluePreferred 80 250 | |
BluePreferred 80 500 | |
BluePreferred 80 1000 | |
BluePreferred 80 2000 | |
BluePreferred Saver 100 1750 | |
BluePreferred Saver 100 3500 | |
BluePreferred Saver 100 5000 |