Mid-Sized Business and Balanced Funding Plan Documents April 2023
Plan Year:
Pharmacy
| Documents | Download/Access |
|---|---|
3 & 4 Tier Standard Plans | |
Coinsurance & Brand-Generic Standard Plans |
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 100BluePreferred 500 100BluePreferred 1000 100BluePreferred 1500 100BluePreferred 2000 100BluePreferred 2500 100BluePreferred 3000 100BluePreferred 4000 100BluePreferred 5000 100BluePreferred 6000 100BluePreferred 8300 100BluePreferred 250 90BluePreferred 500 90BluePreferred 1000 90BluePreferred 1500 90BluePreferred 2000 90BluePreferred 2500 90BluePreferred 3000 90BluePreferred 4000 90BluePreferred 5000 90BluePreferred 6000 90BluePreferred 500 80BluePreferred 1000 80BluePreferred 1500 80BluePreferred 2000 80BluePreferred 2500 80BluePreferred 3000 80BluePreferred 4000 80BluePreferred 5000 80BluePreferred 6000 80BluePreferred 7000 80BluePreferred 1000 70BluePreferred 1500 70BluePreferred 2000 70BluePreferred 2500 70BluePreferred 3000 70BluePreferred 4000 70BluePreferred 5000 70BluePreferred 6000 70BluePreferred 7000 70BluePreferred 8000 70Plans Download BluePreferred HSA Plus 3000 100BluePreferred HSA Plus 4000 100BluePreferred HSA Plus 5000 100BluePreferred HSA Plus 6000 100BluePreferred HSA Plus 7000 100BluePreferred HSA Plus 1500 90BluePreferred HSA Plus 3000 90BluePreferred HSA Plus 4000 90BluePreferred HSA Plus 5000 90BluePreferred HSA Plus 6000 90BluePreferred HSA Plus 3000 80BluePreferred HSA Plus 4000 80BluePreferred HSA Plus 5000 80BluePreferred HSA Plus 6000 80BluePreferred HSA Plus 3000 70BluePreferred HSA Plus 4000 70BluePreferred HSA Plus 5000 70BluePreferred HSA Plus 6000 70Plans Download Ascend HMO Plus 8300 100Ascend HMO Plus 3000 80Ascend HMO Plus 5000 80Ascend HMO Plus 6000 80Ascend HMO Plus 7000 80Ascend HMO Plus 3000 70Ascend HMO Plus 5000 70Ascend HMO Plus 6000 70Ascend HMO Plus 7000 70Ascend HMO Plus 8000 70Plans Download Ascend HSA 3000 90Ascend HSA 5000 90Ascend HSA 6000 90Ascend HSA 3000 80Ascend HSA 5000 80Ascend HSA 6000 80Ascend HSA 3000 70Ascend HSA 5000 70Ascend HSA 6000 70
Benefit Books
| Documents | Download |
|---|---|
| Group BluePreferred PPO Base Benefit Book | |
| Group Ascend HMO Plus Base Benefit Book | |
| Group Ascend HSA HMO Base Benefit Book | |
| Group Ascend HMO PCP Removal Rider |
Documents Download Group BluePreferred PPO 1000 100 Group BluePreferred PPO 1000 70 Group BluePreferred PPO 1000 80 Group BluePreferred PPO 1000 90 Group BluePreferred PPO 1500 100 Group BluePreferred PPO 1500 70 Group BluePreferred PPO 1500 80 Group BluePreferred PPO 1500 90 Group BluePreferred PPO 2000 100 Group BluePreferred PPO 2000 70 Group BluePreferred PPO 2000 80 Group BluePreferred PPO 2000 90 Group BluePreferred PPO 250 100 Group BluePreferred PPO 250 90 Group BluePreferred PPO 2500 100 Group BluePreferred PPO 2500 70 Group BluePreferred PPO 2500 80 Group BluePreferred PPO 2500 90 Group BluePreferred PPO 3000 100 Group BluePreferred PPO 3000 70 Group BluePreferred PPO 3000 80 Group BluePreferred PPO 3000 90 Group BluePreferred PPO 4000 100 Group BluePreferred PPO 4000 70 Group BluePreferred PPO 4000 80 Group BluePreferred PPO 4000 90 Group BluePreferred PPO 500 100 Group BluePreferred PPO 500 80 Group BluePreferred PPO 500 90 Group BluePreferred PPO 5000 100 Group BluePreferred PPO 5000 70 Group BluePreferred PPO 5000 80 Group BluePreferred PPO 5000 90 Group BluePreferred PPO 6000 100 Group BluePreferred PPO 6000 70 Group BluePreferred PPO 6000 80 Group BluePreferred PPO 6000 90 Group BluePreferred PPO 7000 70 Group BluePreferred PPO 7000 80 Group BluePreferred PPO 8000 70 Group BluePreferred PPO 8300 100 Documents Download Group BluePreferred PPO HSA Plus 1500 90 Group BluePreferred PPO HSA Plus 3000 100 Group BluePreferred PPO HSA Plus 3000 70 Group BluePreferred PPO HSA Plus 3000 80 Group BluePreferred PPO HSA Plus 3000 90 Group BluePreferred PPO HSA Plus 4000 100 Group BluePreferred PPO HSA Plus 4000 70 Group BluePreferred PPO HSA Plus 4000 80 Group BluePreferred PPO HSA Plus 4000 90 Group BluePreferred PPO HSA Plus 5000 100 Group BluePreferred PPO HSA Plus 5000 70 Group BluePreferred PPO HSA Plus 5000 80 Group BluePreferred PPO HSA Plus 5000 90 Group BluePreferred PPO HSA Plus 6000 100 Group BluePreferred PPO HSA Plus 6000 70 Group BluePreferred PPO HSA Plus 6000 80 Group BluePreferred PPO HSA Plus 6000 90 Group BluePreferred PPO HSA Plus 7000 100 Documents Download Group Ascend HMO Plus 3000 70 Group Ascend HMO Plus 3000 80 Group Ascend HMO Plus 5000 70 Group Ascend HMO Plus 5000 80 Group Ascend HMO Plus 6000 70 Group Ascend HMO Plus 6000 80 Group Ascend HMO Plus 7000 70 Group Ascend HMO Plus 7000 80 Group Ascend HMO Plus 8000 70 Group Ascend HMO Plus 8300 100 Documents Download Group Ascend HSA HMO 3000 70 Group Ascend HSA HMO 3000 80 Group Ascend HSA HMO 3000 90 Group Ascend HSA HMO 5000 70 Group Ascend HSA HMO 5000 80 Group Ascend HSA HMO 5000 90 Group Ascend HSA HMO 6000 70 Group Ascend HSA HMO 6000 80 Group Ascend HSA HMO 6000 90