Mid-Sized Business and Balanced Funding Plan Documents January 2023
Plan Year:
Pharmacy
| Documents | Download/Access |
|---|---|
3 & 4 Tier Standard Plans BlueSignature Prosano PPO, BluePreferred PPO, Ascend HMO Plus | |
Coinsurance & Brand-Generic Standard Plans BluePreferred PPO HSA, Ascend HSA HMO |
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 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 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 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 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
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 BluePreferred PPO January Rider | |
| Group Ascend HMO January Rider |
Group BluePreferred PPO 1000 100 Group BluePreferred PPO 1500 100 Group BluePreferred PPO 2000 100 Group BluePreferred PPO 250 100 Group BluePreferred PPO 2500 100 Group BluePreferred PPO 3000 100 Group BluePreferred PPO 4000 100 Group BluePreferred PPO 500 100 Group BluePreferred PPO 5000 100 Group BluePreferred PPO 6000 100 Group BluePreferred PPO 8300 100 Group BluePreferred PPO 1000 70 Group BluePreferred PPO 1500 70 Group BluePreferred PPO 2000 70 Group BluePreferred PPO 2500 70 Group BluePreferred PPO 3000 70 Group BluePreferred PPO 4000 70 Group BluePreferred PPO 5000 70 Group BluePreferred PPO 6000 70 Group BluePreferred PPO 7000 70 Group BluePreferred PPO 8000 70 Group BluePreferred PPO 1000 80 Group BluePreferred PPO 1500 80 Group BluePreferred PPO 2000 80 Group BluePreferred PPO 2500 80 Group BluePreferred PPO 3000 80 Group BluePreferred PPO 4000 80 Group BluePreferred PPO 500 80 Group BluePreferred PPO 5000 80 Group BluePreferred PPO 6000 80 Group BluePreferred PPO 7000 80 Group BluePreferred PPO 1000 90 Group BluePreferred PPO 1500 90 Group BluePreferred PPO 2000 90 Group BluePreferred PPO 250 90 Group BluePreferred PPO 2500 90 Group BluePreferred PPO 3000 90 Group BluePreferred PPO 4000 90 Group BluePreferred PPO 500 90 Group BluePreferred PPO 5000 90 Group BluePreferred PPO 6000 90 Group BluePreferred PPO HSA Plus 2800 100 Group BluePreferred PPO HSA Plus 3000 100 Group BluePreferred PPO HSA Plus 4000 100 Group BluePreferred PPO HSA Plus 5000 100 Group BluePreferred PPO HSA Plus 6000 100 Group BluePreferred PPO HSA Plus 7000 100 Group BluePreferred PPO HSA Plus 2800 70 Group BluePreferred PPO HSA Plus 3000 70 Group BluePreferred PPO HSA Plus 4000 70 Group BluePreferred PPO HSA Plus 5000 70 Group BluePreferred PPO HSA Plus 6000 70 Group BluePreferred PPO HSA Plus 2800 80 Group BluePreferred PPO HSA Plus 3000 80 Group BluePreferred PPO HSA Plus 4000 80 Group BluePreferred PPO HSA Plus 5000 80 Group BluePreferred PPO HSA Plus 6000 80 Group BluePreferred PPO HSA Plus 1500 90 Group BluePreferred PPO HSA Plus 2800 90 Group BluePreferred PPO HSA Plus 3000 90 Group BluePreferred PPO HSA Plus 4000 90 Group BluePreferred PPO HSA Plus 5000 90 Group BluePreferred PPO HSA Plus 6000 90 Group Ascend HMO Plus 3000 70 Group Ascend HMO Plus 5000 70 Group Ascend HMO Plus 6000 70 Group Ascend HMO Plus 7000 70 Group Ascend HMO Plus 8000 70 Group Ascend HMO Plus 3000 80 Group Ascend HMO Plus 5000 80 Group Ascend HMO Plus 6000 80 Group Ascend HMO Plus 7000 80 Group Ascend HMO Plus 8300 100 Group Ascend HSA HMO 3000 70 Group Ascend HSA HMO 5000 70 Group Ascend HSA HMO 6000 70 Group Ascend HSA HMO 3000 80 Group Ascend HSA HMO 5000 80 Group Ascend HSA HMO 6000 80 Group Ascend HSA HMO 3000 90 Group Ascend HSA HMO 5000 90 Group Ascend HSA HMO 6000 90