Summary of Benefits Documents - Pharmacy Benefit

Current Documents

Go to the Archive to access documents with pre-7/1/2011 Benefit Effective Date

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Document
Benefit Effective Date
Plan Family
Calendar or Contract Year?
CDHP?
Deductible?
POSA?
Equity Plus 5000/100% Autism1/1/2012PlusContract YearEquityYesNo
Design Plus $10/30/50/100 1/1/2012PlusCalendar YearDesignNoNo
Design Plus RxDed Pharmacy1/1/2012PlusCalendar YearDesignYesNo
Equity Plus Pharmacy1/1/2012PlusCalendar YearEquityYesNo
Plus $100 Deductible $10/30/50/751/1/2012PlusCalendar YearTraditionalYesNo
Plus $10/20/50/751/1/2012PlusCalendar YearTraditionalNoNo
Plus Pharmacy $150 Deductible $103050751/1/2012PlusCalendar YearTraditionalYesNo
Plus Pharmacy $50 Deductible $10305075 1/1/2012PlusCalendar YearTraditionalYesNo
Plus Pharmacy $75 Deductible $10305075 1/1/2012PlusCalendar YearTraditionalYesNo
Plus $100 Deductible $10/30/50/751/1/2012PlusContract YearTraditionalYesNo
Plus $10/20/50/751/1/2012PlusContract YearTraditionalNoNo
Plus $150 Deductible $10/30/50/751/1/2012PlusContract YearTraditionalYesNo
Plus Pharmacy $50 Deductible $103050751/1/2012PlusContract YearTraditionalYesNo
Plus Pharmacy $75 Deductible $10305075 1/1/2012PlusContract YearTraditionalYesNo
Design POSA Pharmacy1/1/2012VantageCalendar YearDesignNoYes
Design Vantage Pharmacy1/1/2012VantageCalendar YearDesignNoNo
Design POSA RxDed Pharmacy1/1/2012VantageCalendar YearDesignYesYes
Design Vant RxDed Pharmacy1/1/2012VantageCalendar YearDesignYesNo
Equity POSA Pharmacy1/1/2012VantageCalendar YearEquityYesYes
Equity Vantage Pharmacy1/1/2012VantageCalendar YearEquityYesNo
POSA Pharmacy $102050751/1/2012VantageCalendar YearTraditionalNoYes
POSA Pharmacy $10/30/50/751/1/2012VantageCalendar YearTraditionalNoYes
POSA Pharmacy $150 Deductible $103050751/1/2012VantageCalendar YearTraditionalYesYes
POSA Pharmacy $50 Deductible $10305075 1/1/2012VantageCalendar YearTraditionalYesYes
POSA Pharmacy $75 Deductible $103050751/1/2012VantageCalendar YearTraditionalYesYes
POSA Pharmacy $10205075 1/1/2012VantageContract YearTraditionalNoYes
POSA Pharmacy $10205075 1/1/2012VantageContract YearTraditionalNoYes
POSA Pharmacy $150 Deductible $103050751/1/2012VantageContract YearTraditionalYesYes
POSA Pharmacy $50 Deductible $10305075 1/1/2012VantageContract YearTraditionalYesYes
POSA Pharmacy $75 Deductible $103050751/1/2012VantageContract YearTraditionalYesYes
Vantage $10/20/50/751/1/2012VantageCalendar YearTraditionalNoNo
Vantage $10/30/50/751/1/2012VantageCalendar YearTraditionalNoNo
Vantage Pharmacy $150 Deductible $103050751/1/2012VantageCalendar YearTraditionalYesNo
Vantage Pharmacy $50 Deductible $10305075 1/1/2012VantageCalendar YearTraditionalYesNo
Vantage Pharmacy $75 Deductible $103050751/1/2012VantageCalendar YearTraditionalYesNo
Vantage Pharmacy $10205075 1/1/2012VantageContract YearTraditionalNoNo
Vantage Pharmacy $10/30/50/751/1/2012VantageContract YearTraditionalNoNo
Vantage Pharmacy $150 Deductible $103050751/1/2012VantageContract YearTraditionalYesNo
Vantage Pharmacy $50 Deductible $10305075 1/1/2012VantageContract YearTraditionalYesNo
Vantage Pharmacy $75 Deductible $103050751/1/2012VantageContract YearTraditionalYesYes
07-2011 Optima Design Pharmacy $10/30/50/100 7/1/2011PlusCalendar YearDesignNoNo
07-2011 Optima Equity Pharmacy $10/30/50/1007/1/2011PlusCalendar YearEquityNoNo
07-2011 Optima Design Plus RxDed $10/30/50/100 7/1/2011PlusCalendar YearDesignYesNo
Plus Pharmacy $100 Deductible $10305075 Contract Yr7/1/2011PlusContract YearTraditionalYesNo
Plus Pharmacy $150 Deductible $10305075 Contract Yr7/1/2011PlusContract YearTraditionalYesNo
Plus Pharmacy $50 Deductible $10305075 Contract Yr7/1/2011PlusContract YearTraditionalYesNo
Plus Pharmacy $75 Deductible $10305075 Contract Yr7/1/2011PlusContract YearTraditionalYesNo
07-2011 Design POSA Rx Ded Pharmacy $10/30/50/100 7/1/2011VantageCalendar YearDesignYesYes
07-2011 Design Vantage Rx Ded Pharmacy $10/30/50/100 7/1/2011VantageCalendar YearDesignYesNo