Mid-Sized Business and Balanced Funding Plan Documents April 2022
Pharmacy
| Documents | Download/Access |
|---|---|
3 & 4 Tier Standard Plans | |
Coinsurance & Brand-Generic Standard Plans |
Benefit Books
| DOCUMENTS | DOWNLOAD |
|---|---|
| Group PPO Base Benefit Book | |
| Group Ascend HMO Plus Base Benefit Book | |
| Group Ascend HSA HMO Base Benefit Book | |
| Group BP PPO January Rider | |
| Group Ascend HMO January Rider | |
| Group Ascend HMO Plus 70 3000 | |
| Group Ascend HMO Plus 70 5000 | |
| Group Ascend HMO Plus 70 6000 | |
| Group Ascend HMO Plus 70 7000 | |
| Group Ascend HMO Plus 70 8000 | |
| Group Ascend HMO Plus 80 3000 | |
| Group Ascend HMO Plus 80 5000 | |
| Group Ascend HMO Plus 80 6000 | |
| Group Ascend HMO Plus 80 7000 | |
| Group Ascend HSA HMO 70 3000 | |
| Group Ascend HSA HMO 70 5000 | |
| Group Ascend HSA HMO 70 6000 | |
| Group Ascend HSA HMO 80 3000 | |
| Group Ascend HSA HMO 80 5000 | |
| Group Ascend HSA HMO 80 6000 | |
| Group Ascend HSA HMO 90 3000 | |
| Group Ascend HSA HMO 90 5000 | |
| Group Ascend HSA HMO 90 6000 | |
| Group Ascend HMO Plus 100 8300 | |
| Group BP PPO 100 1000 | |
| Group BP PPO 100 1500 | |
| Group BP PPO 100 2000 | |
| Group BP PPO 100 250 | |
| Group BP PPO 100 2500 | |
| Group BP PPO 100 3000 | |
| Group BP PPO 100 4000 | |
| Group BP PPO 100 500 | |
| Group BP PPO 100 5000 | |
| Group BP PPO 100 6000 | |
| Group BP PPO 100 8300 | |
| Group BP PPO 70 1000 | |
| Group BP PPO 70 1500 | |
| Group BP PPO 70 2000 | |
| Group BP PPO 70 2500 | |
| Group BP PPO 70 3000 | |
| Group BP PPO 70 4000 | |
| Group BP PPO 70 5000 | |
| Group BP PPO 70 6000 | |
| Group BP PPO 70 7000 | |
| Group BP PPO 70 8000 | |
| Group BP PPO 80 1000 | |
| Group BP PPO 80 1500 | |
| Group BP PPO 80 2000 | |
| Group BP PPO 80 2500 | |
| Group BP PPO 80 3000 | |
| Group BP PPO 80 4000 | |
| Group BP PPO 80 500 | |
| Group BP PPO 80 5000 | |
| Group BP PPO 80 6000 | |
| Group BP PPO 80 7000 | |
| Group BP PPO 90 1000 | |
| Group BP PPO 90 1500 | |
| Group BP PPO 90 2000 | |
| Group BP PPO 90 250 | |
| Group BP PPO 90 2500 | |
| Group BP PPO 90 3000 | |
| Group BP PPO 90 4000 | |
| Group BP PPO 90 500 | |
| Group BP PPO 90 5000 | |
| Group BP PPO 90 6000 | |
| Group BP PPO HSA Plus 100 2800 | |
| Group BP PPO HSA Plus 100 3000 | |
| Group BP PPO HSA Plus 100 4000 | |
| Group BP PPO HSA Plus 100 5000 | |
| Group BP PPO HSA Plus 100 6000 | |
| Group BP PPO HSA Plus 100 7000 | |
| Group BP PPO HSA Plus 70 2800 | |
| Group BP PPO HSA Plus 70 3000 | |
| Group BP PPO HSA Plus 70 4000 | |
| Group BP PPO HSA Plus 70 5000 | |
| Group BP PPO HSA Plus 70 6000 | |
| Group BP PPO HSA Plus 80 2800 | |
| Group BP PPO HSA Plus 80 3000 | |
| Group BP PPO HSA Plus 80 4000 | |
| Group BP PPO HSA Plus 80 5000 | |
| Group BP PPO HSA Plus 80 6000 | |
| Group BP PPO HSA Plus 90 1500 | |
| Group BP PPO HSA Plus 90 2800 | |
| Group BP PPO HSA Plus 90 3000 | |
| Group BP PPO HSA Plus 90 4000 | |
| Group BP PPO HSA Plus 90 5000 | |
| Group BP PPO HSA Plus 90 6000 |
Employer Health Plan Product Guide
| Guide | Download |
|---|---|
Balanced Funding | |
Mid-Sized Business |
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 250 100 - Statewide NetworkBluePreferred 500 100 - Statewide NetworkBluePreferred 1000 100 - Statewide NetworkBluePreferred 1500 100 - Statewide NetworkBluePreferred 2000 100 - Statewide NetworkBluePreferred 2500 100 - Statewide NetworkBluePreferred 3000 100 - Statewide NetworkBluePreferred 4000 100 - Statewide NetworkBluePreferred 5000 100 - Statewide NetworkBluePreferred 6000 100 - Statewide NetworkBluePreferred 8300 100 - Statewide NetworkBluePreferred 3000 100 - Alliance NetworkBluePreferred 4000 100 - Alliance NetworkBluePreferred 5000 100 - Alliance NetworkBluePreferred 6000 100 - Alliance NetworkBluePreferred 8300 100 - Alliance NetworkBluePreferred 3000 100 - PimaConnect NetworkBluePreferred 4000 100 - PimaConnect NetworkBluePreferred 5000 100 - PimaConnect NetworkBluePreferred 6000 100 - PimaConnect NetworkBluePreferred 8300 100 - PimaConnect NetworkBluePreferred 250 90 - Statewide NetworkBluePreferred 500 90 - Statewide NetworkBluePreferred 1000 90 - Statewide NetworkBluePreferred 1500 90 - Statewide NetworkBluePreferred 2000 90 - Statewide NetworkBluePreferred 2500 90 - Statewide NetworkBluePreferred 3000 90 - Statewide NetworkBluePreferred 4000 90 - Statewide NetworkBluePreferred 5000 90 - Statewide NetworkBluePreferred 6000 90 - Statewide NetworkBluePreferred 3000 90 - Alliance NetworkBluePreferred 4000 90 - Alliance NetworkBluePreferred 5000 90 - Alliance NetworkBluePreferred 6000 90 - Alliance NetworkBluePreferred 3000 90 - PimaConnect NetworkBluePreferred 4000 90 - PimaConnect NetworkBluePreferred 5000 90 - PimaConnect NetworkBluePreferred 6000 90 - PimaConnect NetworkBluePreferred 500 80 - Statewide NetworkBluePreferred 1000 80 - Statewide NetworkBluePreferred 1500 80 - Statewide NetworkBluePreferred 2000 80 - Statewide NetworkBluePreferred 2500 80 - Statewide NetworkBluePreferred 3000 80 - Statewide NetworkBluePreferred 4000 80 - Statewide NetworkBluePreferred 5000 80 - Statewide NetworkBluePreferred 6000 80 - Statewide NetworkBluePreferred 7000 80 - Statewide NetworkBluePreferred 1000 80 - Alliance NetworkBluePreferred 3000 80 - Alliance NetworkBluePreferred 4000 80 - Alliance NetworkBluePreferred 5000 80 - Alliance NetworkBluePreferred 6000 80 - Alliance NetworkBluePreferred 7000 80 - Alliance NetworkBluePreferred 1000 80 - PimaConnect NetworkBluePreferred 3000 80 - PimaConnect NetworkBluePreferred 4000 80 - PimaConnect NetworkBluePreferred 5000 80 - PimaConnect NetworkBluePreferred 6000 80 - PimaConnect NetworkBluePreferred 7000 80 - PimaConnect NetworkBluePreferred 1000 70 - Statewide NetworkBluePreferred 1500 70 - Statewide NetworkBluePreferred 2000 70 - Statewide NetworkBluePreferred 2500 70 - Statewide NetworkBluePreferred 3000 70 - Statewide NetworkBluePreferred 4000 70 - Statewide NetworkBluePreferred 5000 70 - Statewide NetworkBluePreferred 6000 70 - Statewide NetworkBluePreferred 7000 70 - Statewide NetworkBluePreferred 8000 70 - Statewide NetworkBluePreferred 1000 70 - Alliance NetworkBluePreferred 3000 70 - Alliance NetworkBluePreferred 4000 70 - Alliance NetworkBluePreferred 5000 70 - Alliance NetworkBluePreferred 6000 70 - Alliance NetworkBluePreferred 7000 70 - Alliance NetworkBluePreferred 8000 70 - Alliance NetworkBluePreferred 1000 70 - PimaConnect NetworkBluePreferred 3000 70 - PimaConnect NetworkBluePreferred 4000 70 - PimaConnect NetworkBluePreferred 5000 70 - PimaConnect NetworkBluePreferred 6000 70 - PimaConnect NetworkBluePreferred 7000 70 - PimaConnect NetworkBluePreferred 8000 70 - PimaConnect NetworkPLANS DOWNLOAD HSA Plus 2800 100 - Statewide NetworkHSA Plus 3000 100 - Statewide NetworkHSA Plus 4000 100 - Statewide NetworkHSA Plus 5000 100 - Statewide NetworkHSA Plus 6000 100 - Statewide NetworkHSA Plus 7000 100 - Statewide NetworkHSA Plus 3000 100 - Alliance NetworkHSA Plus 4000 100 - Alliance NetworkHSA Plus 5000 100 - Alliance NetworkHSA Plus 6000 100 - Alliance NetworkHSA Plus 7000 100 - Alliance NetworkHSA Plus 3000 100 - PimaConnect NetworkHSA Plus 4000 100 - PimaConnect NetworkHSA Plus 5000 100 - PimaConnect NetworkHSA Plus 6000 100 - PimaConnect NetworkHSA Plus 7000 100 - PimaConnect NetworkHSA Plus 1500 90 - Statewide NetworkHSA Plus 2800 90 - Statewide NetworkHSA Plus 3000 90 - Statewide NetworkHSA Plus 4000 90 - Statewide NetworkHSA Plus 5000 90 - Statewide NetworkHSA Plus 6000 90 - Statewide NetworkHSA Plus 3000 90 - Alliance NetworkHSA Plus 4000 90 - Alliance NetworkHSA Plus 5000 90 - Alliance NetworkHSA Plus 6000 90 - Alliance NetworkHSA Plus 3000 90 - PimaConnect NetworkHSA Plus 4000 90 - PimaConnect NetworkHSA Plus 5000 90 - PimaConnect NetworkHSA Plus 6000 90 - PimaConnect NetworkHSA Plus 2800 80 - Statewide NetworkHSA Plus 3000 80 - Statewide NetworkHSA Plus 4000 80 - Statewide NetworkHSA Plus 5000 80 - Statewide NetworkHSA Plus 6000 80 - Statewide NetworkHSA Plus 3000 80 - Alliance NetworkHSA Plus 4000 80 - Alliance NetworkHSA Plus 5000 80 - Alliance NetworkHSA Plus 6000 80 - Alliance NetworkHSA Plus 3000 80 - PimaConnect NetworkHSA Plus 4000 80 - PimaConnect NetworkHSA Plus 5000 80 - PimaConnect NetworkHSA Plus 6000 80 - PimaConnect NetworkHSA Plus 2800 70 - Statewide NetworkHSA Plus 3000 70 - Statewide NetworkHSA Plus 4000 70 - Statewide NetworkHSA Plus 5000 70 - Statewide NetworkHSA Plus 6000 70 - Statewide NetworkHSA Plus 3000 70 - Alliance NetworkHSA Plus 4000 70 - Alliance NetworkHSA Plus 5000 70 - Alliance NetworkHSA Plus 6000 70 - Alliance NetworkHSA Plus 3000 70 - PimaConnect NetworkHSA Plus 4000 70 - PimaConnect NetworkHSA Plus 5000 70 - PimaConnect NetworkHSA Plus 6000 70 - PimaConnect NetworkPLANS DOWNLOAD Ascend Plus 8300 100 - Statewide NetworkAscend Plus 8300 100 - Alliance NetworkAscend Plus 8300 100 - PimaConnect NetworkAscend Plus 3000 80 - Statewide NetworkAscend Plus 5000 80 - Statewide NetworkAscend Plus 6000 80 - Statewide NetworkAscend Plus 7000 80 - Statewide NetworkAscend Plus 3000 80 - Alliance NetworkAscend Plus 5000 80 - Alliance NetworkAscend Plus 6000 80 - Alliance NetworkAscend Plus 7000 80 - Alliance NetworkAscend Plus 3000 80 - PimaConnect NetworkAscend Plus 5000 80 - PimaConnect NetworkAscend Plus 6000 80 - PimaConnect NetworkAscend Plus 7000 80 - PimaConnect NetworkAscend Plus 3000 70 - Statewide NetworkAscend Plus 5000 70 - Statewide NetworkAscend Plus 6000 70 - Statewide NetworkAscend Plus 7000 70 - Statewide NetworkAscend Plus 8000 70 - Statewide NetworkAscend Plus 3000 70 - Alliance NetworkAscend Plus 5000 70 - Alliance NetworkAscend Plus 6000 70 - Alliance NetworkAscend Plus 7000 70 - Alliance NetworkAscend Plus 8000 70 - Alliance NetworkAscend Plus 3000 70 - PimaConnect NetworkAscend Plus 5000 70 - PimaConnect NetworkAscend Plus 6000 70 - PimaConnect NetworkAscend Plus 7000 70 - PimaConnect NetworkAscend Plus 8000 70 - PimaConnect Network- Main Content
PLANS DOWNLOAD Ascend HSA 3000 90 - Statewide NetworkAscend HSA 5000 90 - Statewide NetworkAscend HSA 6000 90 - Statewide NetworkAscend HSA 3000 90 - Alliance NetworkAscend HSA 5000 90 - Alliance NetworkAscend HSA 6000 90 - Alliance NetworkAscend HSA 3000 90 - PimaConnect NetworkAscend HSA 5000 90 - PimaConnect NetworkAscend HSA 6000 90 - PimaConnect NetworkAscend HSA 3000 80 - Statewide NetworkAscend HSA 5000 80 - Statewide NetworkAscend HSA 6000 80 - Statewide NetworkAscend HSA 3000 80 - Alliance NetworkAscend HSA 5000 80 - Alliance NetworkAscend HSA 6000 80 - Alliance NetworkAscend HSA 3000 80 - PimaConnect NetworkAscend HSA 5000 80 - PimaConnect NetworkAscend HSA 6000 80 - PimaConnect NetworkAscend HSA 3000 70 - Statewide NetworkAscend HSA 5000 70 - Statewide NetworkAscend HSA 6000 70 - Statewide NetworkAscend HSA 3000 70 - Alliance NetworkAscend HSA 5000 70 - Alliance NetworkAscend HSA 6000 70 - Alliance NetworkAscend HSA 3000 70 - PimaConnect NetworkAscend HSA 5000 70 - PimaConnect NetworkAscend HSA 6000 70 - PimaConnect Network