Transitional Plans 2024
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.
Documents Download BlueOptimum Plus 250BlueOptimum Plus 500BlueOptimum Plus 1000BlueOptimum Plus 2000BlueOptimum Plus 3000BlueOptimum Plus 5000BlueOptimum Plus 7500BlueOptimum Plus 10000Documents Download BlueValue Plus 500BlueValue Plus 1000BlueValue Plus 2000BlueValue Plus 3000BlueValue Plus 5000BlueValue Plus 7500BlueValue Plus 10000BlueValue Plus Portability 2000Documents Download BlueBasic Plus 500BlueBasic Plus 1000BlueBasic Plus 2000BlueBasic Plus 3000BlueBasic Plus 5000BlueBasic Plus 7500BlueBasic Plus 10000BlueBasic Plus Portability 10000Documents Download BlueEssential Plus 500BlueEssential Plus 1000BlueEssential Plus 2000BlueEssential Plus 3000BlueEssential Plus 5000BlueEssential Plus 7500BlueEssential Plus 10000Plans Download BluePortfolio Plus 70% 1750BluePortfolio Plus 70% 3500BluePortfolio Plus 80% 3500BluePortfolio Plus 90% 1750BluePortfolio Plus 100% 3500BluePortfolio Plus 100% 5500
Benefit Books
| DOCUMENTS | DOWNLOAD |
|---|---|
| Individual PPO |
BlueOptimum Plus PPO 250 80 BlueOptimum Plus PPO 500 80 BlueOptimum Plus PPO 1000 80 BlueOptimum Plus PPO 2000 80 BlueOptimum Plus PPO 3000 80 BlueOptimum Plus PPO 5000 80 BlueOptimum Plus PPO 7500 80 BlueOptimum Plus PPO 10000 80 BlueValue Plus PPO 500 70 BlueValue Plus PPO 1000 70 BlueValue Plus PPO 2000 70 BlueValue Plus PPO 3000 70 BlueValue Plus PPO 5000 70 BlueValue Plus PPO 7500 70 BlueValue Plus PPO 10000 70 BlueBasic Plus PPO 500 80 BlueBasic Plus PPO 1000 80 BlueBasic Plus PPO 2000 80 BlueBasic Plus PPO 3000 80 BlueBasic Plus PPO 5000 80 BlueBasic Plus PPO 7500 80 BlueBasic Plus PPO 10000 80 BlueEssential Plus PPO 500 60 BlueEssential Plus PPO 1000 60 BlueEssential Plus PPO 2000 60 BlueEssential Plus PPO 3000 60 BlueEssential Plus PPO 5000 60 BlueEssential Plus PPO 7500 60 BlueEssential Plus PPO 10000 60 BluePortfolio Plus PPO 1750 70 BluePortfolio Plus PPO 3500 70 BluePortfolio Plus PPO 3500 80 BluePortfolio Plus PPO 1750 90 BluePortfolio Plus PPO 3500 100 BluePortfolio Plus PPO 5500 100