Transitional Plans 2023

Plan Year:

Pharmacy

DOCUMENTSDOWNLOAD/ACCESS
3 & 4 Tier Standard Plans
Coinsurance & Brand-Generic Standard Plans

Benefit Books

DocumentsDownload
Individual PPO
BlueBasic Plus PPO 1000 80
BlueBasic Plus PPO 10000 80
BlueBasic Plus PPO 2000 80
BlueBasic Plus PPO 3000 80
BlueBasic Plus PPO 500 80
BlueBasic Plus PPO 5000 80
BlueBasic Plus PPO 7500 80
BlueEssential Plus PPO 1000 60
BlueEssential Plus PPO 10000 60
BlueEssential Plus PPO 2000 60
BlueEssential Plus PPO 3000 60
BlueEssential Plus PPO 500 60
BlueEssential Plus PPO 5000 60
BlueEssential Plus PPO 7500 60
BlueOptimum Plus PPO 1000 80
BlueOptimum Plus PPO 10000 80
BlueOptimum Plus PPO 2000 80
BlueOptimum Plus PPO 250 80
BlueOptimum Plus PPO 3000 80
BlueOptimum Plus PPO 500 80
BlueOptimum Plus PPO 5000 80
BlueOptimum Plus PPO 7500 80
BluePortfolio Plus PPO 1750 70
BluePortfolio Plus PPO 1750 90
BluePortfolio Plus PPO 3000 100
BluePortfolio Plus PPO 3500 100
BluePortfolio Plus PPO 3500 70
BluePortfolio Plus PPO 3500 80
BluePortfolio Plus PPO 5500 100
BlueValue Plus PPO 1000 70
BlueValue Plus PPO 10000 70
BlueValue Plus PPO 2000 70
BlueValue Plus PPO 3000 70
BlueValue Plus PPO 500 70
BlueValue Plus PPO 5000 70
BlueValue Plus PPO 7500 70

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.