HOPKINS PHARMACY INC
Accepted Insurance Health Plans for NPI 1346753530
Pharmacy - Long Term Care Pharmacy in Titusville, FL
NPI Status: Active since November 09, 2017
Contact Information
4401 S HOPKINS AVE
TITUSVILLE, FL
ZIP 32780
Phone: (321) 607-6802
Fax: (321) 607-6804
- Aetna CVS Health
- Antidote Health Plan of Arizona, Inc.
- Antidote Health Plan of Ohio, Inc.
- Avera Health Plans
- BannerAetna
- Baylor Scott and White Health Plan
- BlueCross BlueShield of Tennessee
- Dean Health Plan
- HealthPartners
- Medica
- Moda Health Plan, Inc.
- Oscar Health Insurance
- Oscar Health Plan of North Carolina, Inc
- Oscar Health Plan, Inc.
- Oscar Insurance Company
- Oscar Insurance Company of Florida
- Oscar Insurance Corporation of Ohio
- SummaCare
Accepted Health Plans and Insurance Coverage
List of insurance companies accepted by HOPKINS PHARMACY INC. Use our filterable tables to quickly find the details of your health plan, including: Plan Name, Plan Type and Plan ID. Search this page to find if your specific insurance is accepted. Please verify directly with the provider to make sure your healthplan is currently accepted.
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze 1 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay | HMO | 99129IL0120001 | No |
| Bronze 2 Advanced HSA: Aetna network + CVS Health Virtual Primary Care | EPO | 48161MO0200003 | No |
| Bronze 2 Advanced HSA: Aetna network + MinuteClinic + Virtual Primary Care | EPO | 84600KS0130001 | No |
| Bronze 2 Advanced HSA: Aetna network + MinuteClinic + Virtual Primary Care | HMO | 38927UT0380001 | No |
| Bronze 2 Advanced HSA: Aetna network + MinuteClinic + Virtual Primary Care | HMO | 61671NC0100001 | No |
| Bronze 2 Advanced HSA: Aetna network + MinuteClinic + Virtual Primary Care | HMO | 84867OH0100001 | No |
| Bronze 2 Advanced HSA: Aetna network + MinuteClinic + Virtual Primary Care | HMO | 96992IN0060001 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 18628FL0160054 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 96992IN0060002 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | EPO | 84600KS0130002 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 61671NC0100016 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 84867OH0100002 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 99129IL0120012 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | EPO | 84600KS0130010 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 18628FL0160060 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 61671NC0100022 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 84867OH0100010 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 96992IN0060010 | No |
| Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 99129IL0120032 | No |
| Bronze 4 Advanced: Aetna network + $0 CVS Health Virtual Primary Care | EPO | 48161MO0200028 | No |
| Bronze 4 Advanced: Aetna network + $0 CVS Health Virtual Primary Care + Adult Dental + Vision | EPO | 48161MO0200040 | No |
| Bronze 4 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 38927UT0380002 | No |
| Bronze S: Aetna network + $0 CVS Health Virtual Primary Care | EPO | 48161MO0200016 | No |
| Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 18628FL0160022 | No |
| Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 96992IN0060003 | No |
| Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | EPO | 84600KS0130003 | No |
| Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 38927UT0380003 | No |
| Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 61671NC0100006 | No |
| Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 84867OH0100003 | No |
| Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 99129IL0120003 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 18628FL0160061 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 96992IN0060011 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | EPO | 84600KS0130011 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 61671NC0100023 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 84867OH0100011 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 99129IL0120033 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | EPO | 84600KS0130012 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 18628FL0160062 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 61671NC0100024 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 84867OH0100012 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 96992IN0060012 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 99129IL0120034 | No |
| Gold 10 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + Adult Dental + Vision | HMO | 58840TX0110147 | No |
| Gold 10 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 38927UT0380010 | No |
| Gold 10: $0 PCP at Aetna network & MinuteClinic Primary Care + $0 CVS Health Virtual Care | HMO | 58840TX0130001 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 18628FL0160055 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 96992IN0060004 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | EPO | 84600KS0130004 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 38927UT0380004 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 61671NC0100017 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 84867OH0100004 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay | HMO | 99129IL0120017 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision | EPO | 84600KS0130013 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 18628FL0160063 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 61671NC0100025 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 96992IN0060013 | No |
| Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision + Rx Copay | HMO | 99129IL0120035 | No |
| Gold 3 Advanced: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 | HMO | 58840TX0110075 | No |
| Gold 3 Advanced: Aetna network + $0 walk-in clinic + Adult Dental + Vision | HMO | 58840TX0110149 | No |
| Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 | HMO | 58840TX0110085 | No |
| Gold S: Aetna network + $0 CVS Health Virtual Primary Care | EPO | 48161MO0200019 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 18628FL0160030 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 96992IN0060005 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | EPO | 84600KS0130005 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 38927UT0380005 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 61671NC0100007 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 67190DE0100008 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 84867OH0100005 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay | HMO | 99129IL0120005 | No |
| Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay | PPO | 72547IL0170005 | No |
| Gold S: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 | HMO | 58840TX0110033 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 18628FL0160064 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 96992IN0060014 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | EPO | 84600KS0130014 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 61671NC0100026 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 84867OH0100013 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 99129IL0120036 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | EPO | 84600KS0130015 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 18628FL0160065 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 61671NC0100027 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 84867OH0100014 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 96992IN0060015 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision | HMO | 99129IL0120037 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 | HMO | 58840TX0110151 | No |
| Silver 10 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + Adult Dental + Vision | HMO | 58840TX0110152 | No |
| Silver 10 Advanced: Aetna network + $0 CVS Health Virtual Primary Care | EPO | 48161MO0200044 | No |
| Silver 10 Advanced: Aetna network + $0 CVS Health Virtual Primary Care + Adult Dental + Vision | EPO | 48161MO0200045 | No |
| Silver 10: $0 PCP at Aetna network & MinuteClinic Primary Care + $0 CVS Health Virtual Care | HMO | 58840TX0130002 | No |
| Silver 5 Advanced: Aetna network + $0 CVS Health Virtual Primary Care | EPO | 48161MO0200015 | No |
| Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 18628FL0160029 | No |
| Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 96992IN0060006 | No |
| Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | EPO | 84600KS0130006 | No |
| Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 38927UT0380006 | No |
| Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 61671NC0100019 | No |
| Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 84867OH0100006 | No |
| Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay | HMO | 99129IL0120006 | No |
| Silver 5 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision + Rx Copay | HMO | 99129IL0120038 | No |
| Silver 5 Advanced: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 | HMO | 58840TX0110103 | No |
| Silver 6 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 38927UT0380008 | No |
| Silver S: Aetna network + $0 CVS Health Virtual Primary Care | EPO | 48161MO0200025 | No |
| Silver S: Aetna network + $0 CVS Health Virtual Primary Care + Adult Dental+Vision | EPO | 48161MO0200046 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 18628FL0160009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 | HMO | 96992IN0060009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 + Adult Dental+Vision | HMO | 18628FL0160067 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 + Adult Dental+Vision | HMO | 96992IN0060016 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | EPO | 84600KS0130009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 38927UT0380009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 61671NC0100009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 67190DE0100009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 84867OH0100009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | HMO | 99129IL0120009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care | PPO | 72547IL0170009 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Adult Dental+Vision | EPO | 84600KS0130016 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Adult Dental+Vision | HMO | 61671NC0100028 | No |
| Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Adult Dental+Vision | HMO | 84867OH0100015 | No |
| Silver S: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 | HMO | 58840TX0110055 | No |
| Silver S: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 + Adult Dental+Vision | HMO | 58840TX0110154 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 68445AZ0600010 | No |
| Bronze Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 68445AZ0600011 | No |
| Bronze Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 68445AZ0610010 | No |
| Bronze Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 68445AZ0610011 | No |
| Bronze Standard | HMO | 68445AZ0590010 | No |
| Catastrophic Standard | HMO | 68445AZ0590050 | No |
| Gold Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 68445AZ0600030 | No |
| Gold Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 68445AZ0600031 | No |
| Gold Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 68445AZ0610030 | No |
| Gold Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 68445AZ0610031 | No |
| Gold Standard | HMO | 68445AZ0590030 | No |
| Silver Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 68445AZ0600020 | No |
| Silver Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 68445AZ0600021 | No |
| Silver Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 68445AZ0610020 | No |
| Silver Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 68445AZ0610021 | No |
| Silver Standard | HMO | 68445AZ0590020 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 31981OH0020010 | No |
| Bronze Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 31981OH0020011 | No |
| Bronze Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 31981OH0030010 | No |
| Bronze Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 31981OH0030011 | No |
| Bronze Standard | HMO | 31981OH0010010 | No |
| Catastrophic Standard | HMO | 31981OH0010050 | No |
| Gold Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 31981OH0020030 | No |
| Gold Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 31981OH0020031 | No |
| Gold Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 31981OH0030030 | No |
| Gold Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 31981OH0030031 | No |
| Gold Standard | HMO | 31981OH0010030 | No |
| Silver Complete $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 31981OH0020020 | No |
| Silver Complete+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx | HMO | 31981OH0020021 | No |
| Silver Elite $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 31981OH0030020 | No |
| Silver Elite+Dental $0 Tier-1 PCP, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx | HMO | 31981OH0030021 | No |
| Silver Standard | HMO | 31981OH0010020 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Avera $1800 | PPO | 60536SD0020064 | No |
| Avera $1800 | PPO | 60536SD0020065 | No |
| Avera $2000 | PPO | 60536SD0020007 | No |
| Avera $2000 | PPO | 60536SD0020041 | No |
| Avera $4000 | PPO | 60536SD0020022 | No |
| Avera $4000 | PPO | 60536SD0020043 | No |
| Avera $4500 | PPO | 60536SD0020039 | No |
| Avera $4500 | PPO | 60536SD0020045 | No |
| Avera $6000 | PPO | 60536SD0020023 | No |
| Avera $6000 | PPO | 60536SD0020046 | No |
| Avera $7500 HSA Eligible HDHP | PPO | 60536SD0020024 | No |
| Avera $7500 HSA Eligible HDHP | PPO | 60536SD0020047 | No |
| Avera $9200 | PPO | 60536SD0020018 | No |
| Avera $9200 | PPO | 60536SD0020050 | No |
| Avera Standard $1500 | PPO | 60536SD0020051 | No |
| Avera Standard $1500 | PPO | 60536SD0020057 | No |
| Avera Standard $5000 | PPO | 60536SD0020052 | No |
| Avera Standard $5000 | PPO | 60536SD0020058 | No |
| Avera Standard $7500 | PPO | 60536SD0020066 | No |
| Avera Standard $7500 | PPO | 60536SD0020067 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| BSW Elite Gold HMO 001 (CMS Standardized Plan with $0 Pediatric PCP copay) | HMO | 40788TX0460001 | No |
| BSW Elite Gold HMO 004 (Two free PCP visits, $0 Pediatric PCP visits) | HMO | 40788TX0460004 | No |
| BSW Elite Gold HMO 012 | HMO | 40788TX0460012 | No |
| BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay) | HMO | 40788TX0460003 | No |
| BSW Prime Silver HMO 008 (Two free PCP visits, $0 Pediatric PCP visit) | HMO | 40788TX0460008 | No |
| BSW Prime Silver HMO 005 | HMO | 40788TX0460005 | No |
| BSW Savers Bronze HMO H S A 006 | HMO | 40788TX0460006 | No |
| BSW Vital Bronze HMO 007 (CMS Standardized Plan with $0 Pediatric PCP copay) | HMO | 40788TX0460007 | No |
| BSW Vital Bronze HMO 009 (One free PCP visit, $0 Pediatric PCP visit) | HMO | 40788TX0460009 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| BlueCross B07E HSA | EPO | 14002TN0400285 | No |
| BlueCross B07E HSA | EPO | 14002TN0400300 | No |
| BlueCross B07E HSA | EPO | 14002TN0400301 | No |
| BlueCross B07E HSA | EPO | 14002TN0400302 | No |
| BlueCross B07S HSA | EPO | 14002TN0400001 | No |
| BlueCross B07S HSA | EPO | 14002TN0400005 | No |
| BlueCross B15E $0 virtual care from Teladoc Health � | EPO | 14002TN0400239 | No |
| BlueCross B15E $0 virtual care from Teladoc Health � | EPO | 14002TN0400240 | No |
| BlueCross B15E $0 virtual care from Teladoc Health � | EPO | 14002TN0400287 | No |
| BlueCross B15E $0 virtual care from Teladoc Health � | EPO | 14002TN0400303 | No |
| BlueCross B15E $0 virtual care from Teladoc Health � | EPO | 14002TN0400304 | No |
| BlueCross B15E $0 virtual care from Teladoc Health � | EPO | 14002TN0400305 | No |
| BlueCross B15S $0 virtual care from Teladoc Health � | EPO | 14002TN0400091 | No |
| BlueCross B15S $0 virtual care from Teladoc Health � | EPO | 14002TN0400097 | No |
| BlueCross B16E $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400253 | No |
| BlueCross B16E $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400254 | No |
| BlueCross B16E $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400288 | No |
| BlueCross B16E $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400306 | No |
| BlueCross B16E $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400307 | No |
| BlueCross B16E $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400308 | No |
| BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400241 | No |
| BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400242 | No |
| BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400243 | No |
| BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400244 | No |
| BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400245 | No |
| BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400246 | No |
| BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400247 | No |
| BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400248 | No |
| BlueCross B17E $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400311 | No |
| BlueCross B17E $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400312 | No |
| BlueCross B17E $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400313 | No |
| BlueCross B17E $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400314 | No |
| BlueCross B17E $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400315 | No |
| BlueCross B17E $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400316 | No |
| BlueCross B17S $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400309 | No |
| BlueCross B17S $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400310 | No |
| BlueCross G06E $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400295 | No |
| BlueCross G06E $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400353 | No |
| BlueCross G06E $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400354 | No |
| BlueCross G06E $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400355 | No |
| BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400200 | No |
| BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400201 | No |
| BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400202 | No |
| BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400203 | No |
| BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400204 | No |
| BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400205 | No |
| BlueCross G08E $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400234 | No |
| BlueCross G08E $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400235 | No |
| BlueCross G08E $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400297 | No |
| BlueCross G08E $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400356 | No |
| BlueCross G08E $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400357 | No |
| BlueCross G08E $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400358 | No |
| BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400222 | No |
| BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400223 | No |
| BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400224 | No |
| BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400225 | No |
| BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400226 | No |
| BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400227 | No |
| BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400228 | No |
| BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400229 | No |
| BlueCross S25E $55 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400255 | No |
| BlueCross S25E $55 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400256 | No |
| BlueCross S25E $55 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400292 | No |
| BlueCross S25E $55 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400328 | No |
| BlueCross S25E $55 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400329 | No |
| BlueCross S25E $55 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400330 | No |
| BlueCross S25S $55 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400188 | No |
| BlueCross S25S $55 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400194 | No |
| BlueCross S26E $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400269 | No |
| BlueCross S26E $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400270 | No |
| BlueCross S26E $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400293 | No |
| BlueCross S26E $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400331 | No |
| BlueCross S26E $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400332 | No |
| BlueCross S26E $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400333 | No |
| BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400257 | No |
| BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400258 | No |
| BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400259 | No |
| BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400260 | No |
| BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400261 | No |
| BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400262 | No |
| BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400263 | No |
| BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400264 | No |
| BlueCross S27E $60 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400294 | No |
| BlueCross S27E $60 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400334 | No |
| BlueCross S27E $60 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400335 | No |
| BlueCross S27E $60 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400336 | No |
| BlueCross S27S $60 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400271 | No |
| BlueCross S27S $60 PCP Copay + $0 virtual care from Teladoc Health � | EPO | 14002TN0400277 | No |
| BlueCross S29E $60 PCP Copay + $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400339 | No |
| BlueCross S29E $60 PCP Copay + $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400340 | No |
| BlueCross S29E $60 PCP Copay + $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400341 | No |
| BlueCross S29E $60 PCP Copay + $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400342 | No |
| BlueCross S29S $60 PCP Copay + $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400337 | No |
| BlueCross S29S $60 PCP Copay + $0 virtual care from Teladoc Health � + Adult Dental | EPO | 14002TN0400338 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Dean Bronze $0 Copay PCP Visits | HMO | 38345WI0010183 | No |
| Dean Bronze Share | HMO | 38345WI0010186 | No |
| Dean Catastrophic | HMO | 38345WI0010063 | No |
| Dean Expanded Bronze Standard | HMO | 38345WI0010164 | No |
| Dean Focus Bronze $0 Copay PCP Visits | EPO | 38345WI0080073 | No |
| Dean Focus Bronze Share | EPO | 38345WI0080076 | No |
| Dean Focus Catastrophic | EPO | 38345WI0080064 | No |
| Dean Focus Expanded Bronze Standard | EPO | 38345WI0080070 | No |
| Dean Focus Gold HSA | EPO | 38345WI0080063 | No |
| Dean Focus Gold Share | EPO | 38345WI0080074 | No |
| Dean Focus Gold Standard | EPO | 38345WI0080068 | No |
| Dean Focus Silver $0 Copay PCP Visits | EPO | 38345WI0080072 | No |
| Dean Focus Silver Share | EPO | 38345WI0080075 | No |
| Dean Focus Silver Standard | EPO | 38345WI0080069 | No |
| Dean Gold HSA | HMO | 38345WI0010158 | No |
| Dean Gold Share | HMO | 38345WI0010184 | No |
| Dean Gold Standard | HMO | 38345WI0010162 | No |
| Dean Silver $0 Copay PCP Visits | HMO | 38345WI0010182 | No |
| Dean Silver Share | HMO | 38345WI0010185 | No |
| Dean Silver Standard | HMO | 38345WI0010163 | No |
| Prevea360 Bronze HSA | HMO | 38345WI0240009 | No |
| Prevea360 Bronze Share | HMO | 38345WI0240022 | No |
| Prevea360 Catastrophic | HMO | 38345WI0240010 | No |
| Prevea360 Expanded Bronze Standard | HMO | 38345WI0240017 | No |
| Prevea360 Gold HSA | HMO | 38345WI0240011 | No |
| Prevea360 Gold Share | HMO | 38345WI0240020 | No |
| Prevea360 Gold Standard | HMO | 38345WI0240015 | No |
| Prevea360 Silver $0 Copay PCP Visits | HMO | 38345WI0240019 | No |
| Prevea360 Silver Share | HMO | 38345WI0240021 | No |
| Prevea360 Silver Standard | HMO | 38345WI0240016 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Atlas $1,000 Gold | PPO | 20173WI0130020 | No |
| Atlas $1,500 Standard Gold | PPO | 20173WI0130040 | No |
| Atlas $2,650 Plus Silver | PPO | 20173WI0130021 | No |
| Atlas $3,500 HSA Silver | PPO | 20173WI0130026 | No |
| Atlas $5,000 Standard Silver | PPO | 20173WI0130041 | No |
| Atlas $6,500 Plus Bronze | PPO | 20173WI0130023 | No |
| Atlas $7,500 Standard Bronze | PPO | 20173WI0130042 | No |
| Atlas $8,200 HSA Bronze | PPO | 20173WI0130027 | No |
| Atlas $9,200 Catastrophic | PPO | 20173WI0130025 | No |
| Robin Oak $1,000 Gold | PPO | 20173WI0130001 | No |
| Robin Oak $1,500 Standard Gold | PPO | 20173WI0130011 | No |
| Robin Select $2,800 Plus Silver | PPO | 20173WI0130033 | No |
| Robin Select $3,500 HSA Silver | PPO | 20173WI0130037 | No |
| Robin Select $5,000 Standard Silver | PPO | 20173WI0130034 | No |
| Robin Select $6,500 Plus Bronze | PPO | 20173WI0130035 | No |
| Robin Select $7,500 Standard Bronze | PPO | 20173WI0130036 | No |
| Robin Select $8,200 HSA Bronze | PPO | 20173WI0130038 | No |
| Robin Select $9,200 Catastrophic | PPO | 20173WI0130039 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Balance by Medica Bronze $0 Copay PCP Visits | EPO | 53461MO0080041 | No |
| Balance by Medica Bronze $0 Copay PCP Visits | PPO | 21333OK0060074 | No |
| Balance by Medica Bronze Premier | EPO | 53461MO0080051 | No |
| Balance by Medica Bronze Premier | PPO | 21333OK0060051 | No |
| Balance by Medica Catastrophic | EPO | 53461MO0080013 | No |
| Balance by Medica Catastrophic | PPO | 21333OK0060013 | No |
| Balance by Medica Expanded Bronze Standard | EPO | 53461MO0080073 | No |
| Balance by Medica Expanded Bronze Standard | PPO | 21333OK0060073 | No |
| Balance by Medica Gold $0 Copay PCP Visits | EPO | 53461MO0080045 | No |
| Balance by Medica Gold $0 Copay PCP Visits | PPO | 21333OK0060045 | No |
| Balance by Medica Gold Share | EPO | 53461MO0080074 | No |
| Balance by Medica Gold Share | PPO | 21333OK0060075 | No |
| Balance by Medica Gold Standard | EPO | 53461MO0080055 | No |
| Balance by Medica Gold Standard | PPO | 21333OK0060055 | No |
| Balance by Medica Silver $0 Copay PCP Visits | EPO | 53461MO0080047 | No |
| Balance by Medica Silver $0 Copay PCP Visits | PPO | 21333OK0060047 | No |
| Balance by Medica Silver Share | EPO | 53461MO0080075 | No |
| Balance by Medica Silver Share | PPO | 21333OK0060076 | No |
| Balance by Medica Silver Standard | EPO | 53461MO0080057 | No |
| Balance by Medica Silver Standard | PPO | 21333OK0060057 | No |
| Harmony by Medica Bronze $0 Copay PCP Visits | PPO | 21333OK0010041 | No |
| Harmony by Medica Bronze $0 Copay PCP Visits + Adult Eye Exam | PPO | 21333OK0070003 | No |
| Harmony by Medica Bronze Premier | PPO | 21333OK0010051 | No |
| Harmony by Medica Bronze Premier + Adult Eye Exam | PPO | 21333OK0070006 | No |
| Harmony by Medica Catastrophic | PPO | 21333OK0010013 | No |
| Harmony by Medica Catastrophic + Adult Eye Exam | PPO | 21333OK0070010 | No |
| Harmony by Medica Expanded Bronze Standard | PPO | 21333OK0010073 | No |
| Harmony by Medica Expanded Bronze Standard + Adult Eye Exam | PPO | 21333OK0070009 | No |
| Harmony by Medica Gold $0 Copay PCP Visits | PPO | 21333OK0010045 | No |
| Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam | PPO | 21333OK0070001 | No |
| Harmony by Medica Gold Share | PPO | 21333OK0010074 | No |
| Harmony by Medica Gold Share + Adult Eye Exam | PPO | 21333OK0070004 | No |
| Harmony by Medica Gold Standard | PPO | 21333OK0010055 | No |
| Harmony by Medica Gold Standard + Adult Eye Exam | PPO | 21333OK0070007 | No |
| Harmony by Medica Silver $0 Copay PCP Visits | PPO | 21333OK0010047 | No |
| Harmony by Medica Silver $0 Copay PCP Visits + Adult Eye Exam | PPO | 21333OK0070002 | No |
| Harmony by Medica Silver Share | PPO | 21333OK0010075 | No |
| Harmony by Medica Silver Share + Adult Eye Exam | PPO | 21333OK0070005 | No |
| Harmony by Medica Silver Standard | PPO | 21333OK0010057 | No |
| Harmony by Medica Silver Standard + Adult Eye Exam | PPO | 21333OK0070008 | No |
| Medica with MU Health Care Bronze $0 Copay PCP Visits | EPO | 53461MO0070041 | No |
| Medica with MU Health Care Bronze Premier | EPO | 53461MO0070051 | No |
| Medica with MU Health Care Catastrophic | EPO | 53461MO0070013 | No |
| Medica with MU Health Care Expanded Bronze Standard | EPO | 53461MO0070073 | No |
| Medica with MU Health Care Gold $0 Copay PCP Visits | EPO | 53461MO0070045 | No |
| Medica with MU Health Care Gold Share | EPO | 53461MO0070074 | No |
| Medica with MU Health Care Gold Standard | EPO | 53461MO0070055 | No |
| Medica with MU Health Care Silver $0 Copay PCP Visits | EPO | 53461MO0070047 | No |
| Medica with MU Health Care Silver Share | EPO | 53461MO0070075 | No |
| Medica with MU Health Care Silver Standard | EPO | 53461MO0070057 | No |
| Select by Medica Bronze $0 Copay PCP Visits | EPO | 53461MO0010041 | No |
| Select by Medica Bronze Share | EPO | 53461MO0010029 | No |
| Select by Medica Catastrophic | EPO | 53461MO0010013 | No |
| Select by Medica Expanded Bronze Standard | EPO | 53461MO0010073 | No |
| Select by Medica Gold $0 Copay PCP Visits | EPO | 53461MO0010045 | No |
| Select by Medica Gold Share | EPO | 53461MO0010074 | No |
| Select by Medica Gold Standard | EPO | 53461MO0010055 | No |
| Select by Medica Silver $0 Copay PCP Visits | EPO | 53461MO0010047 | No |
| Select by Medica Silver Share | EPO | 53461MO0010075 | No |
| Select by Medica Silver Standard | EPO | 53461MO0010057 | No |
| WellFirst by Medica Bronze $0 Copay PCP Visits | EPO | 47840MO0010021 | No |
| WellFirst by Medica Bronze Share | EPO | 47840MO0010022 | No |
| WellFirst by Medica Catastrophic | EPO | 47840MO0010010 | No |
| WellFirst by Medica Expanded Bronze Standard | EPO | 47840MO0010017 | No |
| WellFirst by Medica Gold $0 Copay PCP Visits | EPO | 47840MO0010019 | No |
| WellFirst by Medica Gold Copay Plus | EPO | 47840MO0010001 | No |
| WellFirst by Medica Gold Standard | EPO | 47840MO0010015 | No |
| WellFirst by Medica Silver $0 Copay PCP Visits | EPO | 47840MO0010020 | No |
| WellFirst by Medica Silver Copay Plus | EPO | 47840MO0010002 | No |
| WellFirst by Medica Silver Standard | EPO | 47840MO0010016 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Moda Health Affinity Bronze 7750 | EPO | 39424OR1680005 | No |
| Moda Health Affinity Bronze 9000 | EPO | 39424OR1660002 | No |
| Moda Health Affinity Bronze HDHP 7500 | EPO | 39424OR1680007 | No |
| Moda Health Affinity Gold 1000 | EPO | 39424OR1700001 | No |
| Moda Health Affinity Gold 1500 | EPO | 39424OR1680008 | No |
| Moda Health Affinity Gold 250 | EPO | 39424OR1690001 | No |
| Moda Health Affinity Silver 3000 | EPO | 39424OR1690003 | No |
| Moda Health Affinity Silver 3400 | EPO | 39424OR1680002 | No |
| Moda Health Affinity Silver 4500 | EPO | 39424OR1680004 | No |
| Moda Health Affinity Silver 6000 | EPO | 39424OR1660001 | No |
| Moda Health Oregon Standard Bronze Affinity | EPO | 39424OR1670003 | No |
| Moda Health Oregon Standard Gold Affinity | EPO | 39424OR1670001 | No |
| Moda Health Oregon Standard Silver Affinity | EPO | 39424OR1670002 | No |
| Moda Pioneer Alaska Standard Bronze | PPO | 73836AK0960001 | No |
| Moda Pioneer Alaska Standard Gold | PPO | 73836AK0940001 | No |
| Moda Pioneer Alaska Standard Silver | PPO | 73836AK0950001 | No |
| Moda Pioneer Bronze 6500 | PPO | 73836AK0930003 | No |
| Moda Pioneer Bronze HDHP 5500 | PPO | 73836AK0970002 | No |
| Moda Pioneer Gold 1500 | PPO | 73836AK0930001 | No |
| Moda Pioneer Silver 4500 | PPO | 73836AK0930002 | No |
| Moda Select Bronze 8700 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010006 | No |
| Moda Select Bronze HDHP 7500 | EPO | 17933TX0010007 | No |
| Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010001 | No |
| Moda Select Gold 1800 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010002 | No |
| Moda Select Silver 3500 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010003 | No |
| Moda Select Silver 4800 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010004 | No |
| Moda Select Silver 6400 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010005 | No |
| Moda Select Texas Standard Bronze | EPO | 17933TX0010010 | No |
| Moda Select Texas Standard Gold | EPO | 17933TX0010009 | No |
| Moda Select Texas Standard Silver | EPO | 17933TX0010008 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze Classic 4700 (Select) | HMO | 29341OH0100024 | No |
| Bronze Classic PCP Saver (Select) | HMO | 29341OH0100002 | No |
| Bronze Classic Standard (Select) | HMO | 29341OH0100050 | No |
| Gold Classic (Select) | HMO | 29341OH0100013 | No |
| Gold Classic Standard (Select) | HMO | 29341OH0100053 | No |
| Gold Elite Saver Plus (Select) | HMO | 29341OH0100035 | No |
| Secure (Select) | HMO | 29341OH0100011 | No |
| Silver Classic Standard (Select) | HMO | 29341OH0100052 | No |
| Silver Elite Saver Plus (Select) | HMO | 29341OH0100030 | No |
| Silver Simple Chronic Care CKM (Select) | HMO | 29341OH0100060 | No |
| Silver Simple PCP Saver (Select) | HMO | 29341OH0100025 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze Classic 4700 | HMO | 69803NC0010024 | No |
| Bronze Classic 4700 | with Atrium Health | HMO | 69803NC0010061 | No |
| Bronze Classic Standard | HMO | 69803NC0010050 | No |
| Bronze Classic Standard | with Atrium Health | HMO | 69803NC0010055 | No |
| Bronze Elite + PCP Saver Plus | HMO | 69803NC0010005 | No |
| Bronze Elite + PCP Saver Plus | with Atrium Health | HMO | 69803NC0010062 | No |
| Gold Classic Standard | HMO | 69803NC0010053 | No |
| Gold Classic Standard | with Atrium Health | HMO | 69803NC0010057 | No |
| Gold Elite Saver Plus | HMO | 69803NC0010035 | No |
| Gold Elite Saver Plus | with Atrium Health | HMO | 69803NC0010066 | No |
| Secure | HMO | 69803NC0010011 | No |
| Secure | with Atrium Health | HMO | 69803NC0010060 | No |
| Silver Classic | HMO | 69803NC0010006 | No |
| Silver Classic | with Atrium Health | HMO | 69803NC0010063 | No |
| Silver Classic Standard | HMO | 69803NC0010052 | No |
| Silver Classic Standard | with Atrium Health | HMO | 69803NC0010056 | No |
| Silver Simple Diabetes | HMO | 69803NC0010045 | No |
| Silver Simple Diabetes | with Atrium Health | HMO | 69803NC0010064 | No |
| Silver Simple PCP Saver | HMO | 69803NC0010025 | No |
| Silver Simple PCP Saver | with Atrium Health | HMO | 69803NC0010065 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze Classic 4700 | HMO | 13877AZ0070024 | No |
| Bronze Classic 4700 (Select) | HMO | 11574IL0020024 | No |
| Bronze Classic PCP Saver Plus Rx Copay (Select) | HMO | 11574IL0020021 | No |
| Bronze Classic Standard | HMO | 13877AZ0070050 | No |
| Bronze Classic Standard (Choice) | HMO | 11574IL0010050 | No |
| Bronze Classic Standard (Select) | HMO | 11574IL0020050 | No |
| Bronze Elite + PCP Saver Plus | HMO | 13877AZ0070005 | No |
| Gold Classic | HMO | 13877AZ0070013 | No |
| Gold Classic Standard | HMO | 13877AZ0070053 | No |
| Gold Classic Standard (Choice) | HMO | 11574IL0010053 | No |
| Gold Classic Standard (Select) | HMO | 11574IL0020053 | No |
| Secure | HMO | 13877AZ0070011 | No |
| Secure (Choice) | HMO | 11574IL0010011 | No |
| Silver Classic Standard | HMO | 13877AZ0070052 | No |
| Silver Classic Standard (Choice) | HMO | 11574IL0010052 | No |
| Silver Classic Standard (Select) | HMO | 11574IL0020052 | No |
| Silver Elite Saver Plus | HMO | 13877AZ0070030 | No |
| Silver Elite Saver Plus Rx Copay (Select) | HMO | 11574IL0020030 | No |
| Silver Simple Chronic Care CKM | HMO | 13877AZ0070060 | No |
| Silver Simple Diabetes (Choice) | HMO | 11574IL0010045 | No |
| Silver Simple Diabetes (Select) | HMO | 11574IL0020060 | No |
| Silver Simple PCP Saver | HMO | 13877AZ0070025 | No |
| Silver Simple PCP Saver (Select) | HMO | 11574IL0020025 | No |
| Silver Simple Specialist Saver with COPD | HMO | 13877AZ0070008 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze Classic | EPO | 57424NE0010003 | No |
| Bronze Classic 4700 | EPO | 23552TN0020024 | No |
| Bronze Classic 4700 | EPO | 43490KS0010024 | No |
| Bronze Classic 4700 | EPO | 45819IA0010060 | No |
| Bronze Classic 4700 | EPO | 69512MO0010024 | No |
| Bronze Classic 4700 | EPO | 77739MI0070024 | No |
| Bronze Classic 4700 | PPO | 91908OK0010024 | No |
| Bronze Classic 4700 | MercyOne | EPO | 45819IA0010024 | No |
| Bronze Classic Standard | EPO | 23552TN0020050 | No |
| Bronze Classic Standard | EPO | 43490KS0010050 | No |
| Bronze Classic Standard | EPO | 45819IA0010065 | No |
| Bronze Classic Standard | EPO | 57424NE0010050 | No |
| Bronze Classic Standard | EPO | 69512MO0010050 | No |
| Bronze Classic Standard | EPO | 77739MI0070050 | No |
| Bronze Classic Standard | PPO | 91908OK0010050 | No |
| Bronze Classic Standard | MercyOne | EPO | 45819IA0010050 | No |
| Bronze Elite + PCP Saver | EPO | 43490KS0010005 | No |
| Bronze Elite + PCP Saver Plus | EPO | 23552TN0020005 | No |
| Bronze Elite + PCP Saver Plus | EPO | 45819IA0010056 | No |
| Bronze Elite + PCP Saver Plus | EPO | 57424NE0010005 | No |
| Bronze Elite + PCP Saver Plus | EPO | 69512MO0010005 | No |
| Bronze Elite + PCP Saver Plus | EPO | 77739MI0070005 | No |
| Bronze Elite + PCP Saver Plus | PPO | 91908OK0010005 | No |
| Bronze Elite + PCP Saver Plus | MercyOne | EPO | 45819IA0010005 | No |
| Gold Classic | EPO | 23552TN0020013 | No |
| Gold Classic Standard | EPO | 23552TN0020053 | No |
| Gold Classic Standard | EPO | 43490KS0010053 | No |
| Gold Classic Standard | EPO | 45819IA0010067 | No |
| Gold Classic Standard | EPO | 57424NE0010053 | No |
| Gold Classic Standard | EPO | 69512MO0010053 | No |
| Gold Classic Standard | EPO | 77739MI0070053 | No |
| Gold Classic Standard | PPO | 91908OK0010053 | No |
| Gold Classic Standard | MercyOne | EPO | 45819IA0010053 | No |
| Gold Elite | EPO | 23552TN0020036 | No |
| Gold Elite | EPO | 45819IA0010063 | No |
| Gold Elite | EPO | 57424NE0010036 | No |
| Gold Elite | MercyOne | EPO | 45819IA0010036 | No |
| Gold Elite Saver Plus | EPO | 77739MI0070035 | No |
| Secure | EPO | 23552TN0020011 | No |
| Secure | EPO | 43490KS0010011 | No |
| Secure | EPO | 45819IA0010058 | No |
| Secure | EPO | 57424NE0010011 | No |
| Secure | EPO | 69512MO0010011 | No |
| Secure | EPO | 77739MI0070011 | No |
| Secure | PPO | 91908OK0010011 | No |
| Secure | MercyOne | EPO | 45819IA0010011 | No |
| Silver Classic | EPO | 23552TN0020006 | No |
| Silver Classic | EPO | 43490KS0010006 | No |
| Silver Classic | EPO | 45819IA0010057 | No |
| Silver Classic | EPO | 57424NE0010006 | No |
| Silver Classic | EPO | 77739MI0070006 | No |
| Silver Classic | MercyOne | EPO | 45819IA0010006 | No |
| Silver Classic Standard | EPO | 23552TN0020052 | No |
| Silver Classic Standard | EPO | 43490KS0010052 | No |
| Silver Classic Standard | EPO | 45819IA0010066 | No |
| Silver Classic Standard | EPO | 57424NE0010052 | No |
| Silver Classic Standard | EPO | 69512MO0010052 | No |
| Silver Classic Standard | EPO | 77739MI0070052 | No |
| Silver Classic Standard | PPO | 91908OK0010052 | No |
| Silver Classic Standard | MercyOne | EPO | 45819IA0010052 | No |
| Silver Elite Saver Plus | EPO | 69512MO0010030 | No |
| Silver Elite Saver Plus | PPO | 91908OK0010030 | No |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | EPO | 23552TN0020056 | No |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | PPO | 91908OK0010055 | No |
| Silver Simple Diabetes | EPO | 23552TN0020055 | No |
| Silver Simple Diabetes | EPO | 43490KS0010045 | No |
| Silver Simple Diabetes | EPO | 45819IA0010064 | No |
| Silver Simple Diabetes | EPO | 57424NE0010045 | No |
| Silver Simple Diabetes | EPO | 69512MO0010045 | No |
| Silver Simple Diabetes | PPO | 91908OK0010045 | No |
| Silver Simple Diabetes | MercyOne | EPO | 45819IA0010045 | No |
| Silver Simple PCP Saver | EPO | 23552TN0020025 | No |
| Silver Simple PCP Saver | EPO | 43490KS0010025 | No |
| Silver Simple PCP Saver | EPO | 45819IA0010061 | No |
| Silver Simple PCP Saver | EPO | 57424NE0010025 | No |
| Silver Simple PCP Saver | EPO | 69512MO0010025 | No |
| Silver Simple PCP Saver | EPO | 77739MI0070025 | No |
| Silver Simple PCP Saver | PPO | 91908OK0010025 | No |
| Silver Simple PCP Saver | MercyOne | EPO | 45819IA0010025 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze Classic 4700 | EPO | 40572FL0070024 | No |
| Bronze Classic 4700 | EPO | 40572FL0200024 | No |
| Bronze Classic Standard | EPO | 40572FL0070050 | No |
| Bronze Classic Standard | EPO | 40572FL0200050 | No |
| Bronze Elite + PCP Saver Plus | EPO | 40572FL0070005 | No |
| Bronze Elite + PCP Saver Plus | EPO | 40572FL0200005 | No |
| Gold Classic Standard | EPO | 40572FL0070053 | No |
| Gold Classic Standard | EPO | 40572FL0200053 | No |
| Gold Elite | EPO | 40572FL0070036 | No |
| Gold Elite Saver Plus | EPO | 40572FL0070035 | No |
| Secure | EPO | 40572FL0070011 | No |
| Secure | EPO | 40572FL0200011 | No |
| Silver Classic Standard | EPO | 40572FL0070052 | No |
| Silver Classic Standard | EPO | 40572FL0200052 | No |
| Silver Elite | EPO | 40572FL0070016 | No |
| Silver Elite | EPO | 40572FL0200016 | No |
| Silver Simple Chronic Care CKM | EPO | 40572FL0070060 | No |
| Silver Simple Chronic Care CKM | EPO | 40572FL0200060 | No |
| Silver Simple Diabetes | EPO | 40572FL0070061 | No |
| Silver Simple Diabetes | EPO | 40572FL0200061 | No |
| Silver Simple PCP Saver | EPO | 40572FL0070025 | No |
| Silver Simple PCP Saver | EPO | 40572FL0200025 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze Classic PCP Saver | HMO | 45845OH0100002 | No |
| Bronze Classic Standard | HMO | 45845OH0100050 | No |
| Bronze Simple HSA | HMO | 45845OH0100014 | No |
| Gold Classic Standard | HMO | 45845OH0100053 | No |
| Gold Elite | HMO | 45845OH0100036 | No |
| Gold Elite Saver Plus | HMO | 45845OH0100035 | No |
| Secure | HMO | 45845OH0100011 | No |
| Silver Classic Standard | HMO | 45845OH0100052 | No |
| Silver Elite Saver Plus | HMO | 45845OH0100030 | No |
| Silver Simple Chronic Care CKM | HMO | 45845OH0100060 | No |
| Silver Simple Diabetes | HMO | 45845OH0100045 | No |
| Silver Simple PCP Saver | HMO | 45845OH0100025 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| SummaCare Bronze 8000 | HMO | 52664OH1530023 | No |
| SummaCare Bronze 8000 with Adult Vision Exam | HMO | 52664OH1540003 | No |
| SummaCare Bronze 9200 with 3 Free PCP Visits | HMO | 52664OH1530022 | No |
| SummaCare Bronze 9200 with 3 Free PCP Visits + Adult Vision | HMO | 52664OH1540002 | No |
| SummaCare Gold 2000 with 3 Free PCP Visits | HMO | 52664OH1530026 | No |
| SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision | HMO | 52664OH1540006 | No |
| SummaCare Silver 3500 with 3 Free PCP Visits + Adult Vision | HMO | 52664OH1540005 | No |
| SummaCare Silver 5000 1000 Rx with 3 Free PCP Visits | HMO | 52664OH1530025 | No |
| SummaCare Silver 6000 with 3 Free PCP Visits + Adult Vision Exam | HMO | 52664OH1540004 | No |
| SummaCare Silver 7000 with 3 Free PCP Visits | HMO | 52664OH1530030 | No |
| SummaCare Standard Bronze | HMO | 52664OH1530032 | No |
| SummaCare Standard Bronze with Adult Vision | HMO | 52664OH1540010 | No |
| SummaCare Standard Gold | HMO | 52664OH1530036 | No |
| SummaCare Standard Gold with Adult Vision | HMO | 52664OH1540012 | No |
| SummaCare Standard Silver | HMO | 52664OH1530035 | No |
| SummaCare Standard Silver with Adult Vision | HMO | 52664OH1540011 | No |
| SummaCare Value with 3 Free PCP Visits + Adult Vision | HMO | 52664OH1540001 | No |