MILAN PHARMACY
Accepted Insurance Health Plans for NPI 1346898889
Pharmacy in Indianapolis, IN
NPI Status: Active since August 28, 2019
Contact Information
1935 N CAPITOL AVE STE 120
INDIANAPOLIS, IN
ZIP 46202
Phone: (317) 755-2479
Fax: (317) 870-3968
- 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
- Blue Cross and Blue Shield of Alabama
- Blue Cross and Blue Shield of Illinois
- Blue Cross and Blue Shield of Kansas City
- Blue Cross and Blue Shield of Montana
- Blue Cross and Blue Shield of Nebraska
- Blue Cross and Blue Shield of Oklahoma
- Blue Cross and Blue Shield of Texas
- Blue Cross Blue Shield of North Dakota
- Blue Cross Blue Shield of Wyoming
- BlueCross BlueShield of Tennessee
- Common Ground Healthcare Cooperative
- Dean Health Plan
- Florida Blue (BlueCross BlueShield FL)
- Florida Blue HMO (a BlueCross BlueShield FL company)
- Humana
- Medica
- 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
- Sanford Health Plan
- UnitedHealthcare
Accepted Health Plans and Insurance Coverage
List of insurance companies accepted by MILAN PHARMACY. 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 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 004 (Two free PCP visits, $0 Pediatric PCP visits) | HMO | 40788TX0460004 | No |
| BSW Elite Gold HMO 012 | HMO | 40788TX0460012 | 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 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 008 (Two free PCP visits, $0 Pediatric PCP visit) | HMO | 40788TX0460008 | No |
| BSW Prime Silver HMO 005 | HMO | 40788TX0460005 | No |
| BSW Prime Silver HMO 005 | HMO | 40788TX0460005 | No |
| BSW Savers Bronze HMO H S A 006 | HMO | 40788TX0460006 | 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 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 |
| 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? |
|---|---|---|---|
| Blue Cross Select Gold | PPO | 46944AL0650001 | No |
| Blue Cross Select Silver | PPO | 46944AL0660001 | No |
| Blue HSA Bronze | PPO | 46944AL0560001 | No |
| Blue Protect | PPO | 46944AL0470001 | No |
| Blue Saver Bronze | PPO | 46944AL0460001 | No |
| Blue Saver Silver EPO | EPO | 46944AL0710001 | No |
| Blue Standardized Bronze | PPO | 46944AL0750001 | No |
| Blue Standardized Gold | PPO | 46944AL0720001 | No |
| Blue Standardized Silver | PPO | 46944AL0730001 | No |
| Blue Standardized Silver EPO | EPO | 46944AL0740001 | No |
| Blue Value Gold | PPO | 46944AL0370001 | No |
| Blue Value Silver | PPO | 46944AL0410001 | No |
| Blue Access Gold for Business | PPO | 46944AL0340001 | No |
| Blue Choice Platinum for Business | PPO | 46944AL0280001 | No |
| Blue HSA Silver for Business | PPO | 46944AL0680001 | No |
| Blue Saver Bronze for Business | PPO | 46944AL0430001 | No |
| Blue Saver Gold for Business | PPO | 46944AL0760001 | No |
| Blue Secure Gold for Business | PPO | 46944AL0670001 | No |
| Blue Secure Silver for Business | PPO | 46944AL0380001 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990127 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990188 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990189 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990190 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990191 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990192 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990193 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990194 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990195 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990196 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990197 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990198 | No |
| Blue Choice Preferred Bronze PPO? 201 | PPO | 36096IL0990199 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990265 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990267 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990268 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990269 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990270 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990271 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990272 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990273 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990274 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990275 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990276 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990277 | No |
| Blue Choice Preferred Bronze PPO? 701 | PPO | 36096IL0990278 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990306 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990332 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990333 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990334 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990335 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990336 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990337 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990338 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990339 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990340 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990341 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990342 | No |
| Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays | PPO | 36096IL0990343 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990122 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990128 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990129 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990130 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990131 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990132 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990133 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990134 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990135 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990136 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990137 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990138 | No |
| Blue Choice Preferred Gold PPO? 204 | PPO | 36096IL0990139 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990279 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990282 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990283 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990284 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990285 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990286 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990287 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990288 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990289 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990290 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990291 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990292 | No |
| Blue Choice Preferred Gold PPO? Standard - Rx Copays | PPO | 36096IL0990293 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990126 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990176 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990177 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990178 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990179 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990180 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990181 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990182 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990183 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990184 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990185 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990186 | No |
| Blue Choice Preferred Security PPO? 200 | PPO | 36096IL0990187 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990123 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990140 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990141 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990142 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990143 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990144 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990145 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990146 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990147 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990148 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990149 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990150 | No |
| Blue Choice Preferred Silver PPO? 203 | PPO | 36096IL0990151 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990361 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990362 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990363 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990364 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990365 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990366 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990367 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990368 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990369 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990370 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990371 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990372 | No |
| Blue Choice Preferred Silver PPO? 801 | PPO | 36096IL0990373 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990280 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990294 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990295 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990296 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990297 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990298 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990299 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990300 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990344 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990345 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990346 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990347 | No |
| Blue Choice Preferred Silver PPO? Standard - Select Rx Copays | PPO | 36096IL0990348 | No |
| Blue Precision Bronze HMO? 205 | HMO | 36096IL0810083 | No |
| Blue Precision Bronze HMO? 205 | HMO | 36096IL0810108 | No |
| Blue Precision Bronze HMO? 205 | HMO | 36096IL0810109 | No |
| Blue Precision Bronze HMO? 205 | HMO | 36096IL0810110 | No |
| Blue Precision Bronze HMO? 205 | HMO | 36096IL0810111 | No |
| Blue Precision Bronze HMO? 205 | HMO | 36096IL0810112 | No |
| Blue Precision Bronze HMO? 701 | HMO | 36096IL0810123 | No |
| Blue Precision Bronze HMO? 701 | HMO | 36096IL0810134 | No |
| Blue Precision Bronze HMO? 701 | HMO | 36096IL0810135 | No |
| Blue Precision Bronze HMO? 701 | HMO | 36096IL0810136 | No |
| Blue Precision Bronze HMO? 701 | HMO | 36096IL0810137 | No |
| Blue Precision Bronze HMO? 701 | HMO | 36096IL0810138 | No |
| Blue Precision Bronze HMO? Standard - Select Rx Copays | HMO | 36096IL0810172 | No |
| Blue Precision Bronze HMO? Standard - Select Rx Copays | HMO | 36096IL0810173 | No |
| Blue Precision Bronze HMO? Standard - Select Rx Copays | HMO | 36096IL0810174 | No |
| Blue Precision Bronze HMO? Standard - Select Rx Copays | HMO | 36096IL0810175 | No |
| Blue Precision Bronze HMO? Standard - Select Rx Copays | HMO | 36096IL0810176 | No |
| Blue Precision Bronze HMO? Standard - Select Rx Copays | HMO | 36096IL0810177 | No |
| Blue Precision Gold HMO? 207 | HMO | 36096IL0810080 | No |
| Blue Precision Gold HMO? 207 | HMO | 36096IL0810090 | No |
| Blue Precision Gold HMO? 207 | HMO | 36096IL0810091 | No |
| Blue Precision Gold HMO? 207 | HMO | 36096IL0810092 | No |
| Blue Precision Gold HMO? 207 | HMO | 36096IL0810093 | No |
| Blue Precision Gold HMO? 207 | HMO | 36096IL0810094 | No |
| Blue Precision Gold HMO? 703 | HMO | 36096IL0810121 | No |
| Blue Precision Gold HMO? 703 | HMO | 36096IL0810124 | No |
| Blue Precision Gold HMO? 703 | HMO | 36096IL0810125 | No |
| Blue Precision Gold HMO? 703 | HMO | 36096IL0810126 | No |
| Blue Precision Gold HMO? 703 | HMO | 36096IL0810127 | No |
| Blue Precision Gold HMO? 703 | HMO | 36096IL0810128 | No |
| Blue Precision Gold HMO? Standard - Rx Copays | HMO | 36096IL0810139 | No |
| Blue Precision Gold HMO? Standard - Rx Copays | HMO | 36096IL0810142 | No |
| Blue Precision Gold HMO? Standard - Rx Copays | HMO | 36096IL0810143 | No |
| Blue Precision Gold HMO? Standard - Rx Copays | HMO | 36096IL0810144 | No |
| Blue Precision Gold HMO? Standard - Rx Copays | HMO | 36096IL0810145 | No |
| Blue Precision Gold HMO? Standard - Rx Copays | HMO | 36096IL0810146 | No |
| Blue Precision Silver HMO? 206 | HMO | 36096IL0810081 | No |
| Blue Precision Silver HMO? 206 | HMO | 36096IL0810096 | No |
| Blue Precision Silver HMO? 206 | HMO | 36096IL0810097 | No |
| Blue Precision Silver HMO? 206 | HMO | 36096IL0810098 | No |
| Blue Precision Silver HMO? 206 | HMO | 36096IL0810099 | No |
| Blue Precision Silver HMO? 206 | HMO | 36096IL0810100 | No |
| Blue Precision Silver HMO? 704 | HMO | 36096IL0810122 | No |
| Blue Precision Silver HMO? 704 | HMO | 36096IL0810129 | No |
| Blue Precision Silver HMO? 704 | HMO | 36096IL0810130 | No |
| Blue Precision Silver HMO? 704 | HMO | 36096IL0810131 | No |
| Blue Precision Silver HMO? 704 | HMO | 36096IL0810132 | No |
| Blue Precision Silver HMO? 704 | HMO | 36096IL0810133 | No |
| Blue Precision Silver HMO? Standard - Select Rx Copays | HMO | 36096IL0810140 | No |
| Blue Precision Silver HMO? Standard - Select Rx Copays | HMO | 36096IL0810147 | No |
| Blue Precision Silver HMO? Standard - Select Rx Copays | HMO | 36096IL0810148 | No |
| Blue Precision Silver HMO? Standard - Select Rx Copays | HMO | 36096IL0810149 | No |
| Blue Precision Silver HMO? Standard - Select Rx Copays | HMO | 36096IL0810150 | No |
| Blue Precision Silver HMO? Standard - Select Rx Copays | HMO | 36096IL0810151 | No |
| BlueCare Direct Bronze? Standard - Select Rx Copays with Advocate | HMO | 36096IL0810195 | No |
| BlueCare Direct Bronze? Standard - Select Rx Copays with Advocate | HMO | 36096IL0810212 | No |
| BlueCare Direct Bronze? Standard - Select Rx Copays with Advocate | HMO | 36096IL0810213 | No |
| BlueCare Direct Gold? Standard - Rx Copays with Advocate | HMO | 36096IL0810193 | No |
| BlueCare Direct Gold? Standard - Rx Copays with Advocate | HMO | 36096IL0810208 | No |
| BlueCare Direct Gold? Standard - Rx Copays with Advocate | HMO | 36096IL0810209 | No |
| BlueCare Direct Silver? Standard - Select Rx Copays with Advocate | HMO | 36096IL0810194 | No |
| BlueCare Direct Silver? Standard - Select Rx Copays with Advocate | HMO | 36096IL0810210 | No |
| BlueCare Direct Silver? Standard - Select Rx Copays with Advocate | HMO | 36096IL0810211 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Blue KC Catastrophic BlueSelect EPO | EPO | 34762MO0590023 | No |
| Blue KC Catastrophic BlueSelect EPO | EPO | 94248KS0560012 | No |
| Blue KC Choice Bronze 2 BlueSelect EPO with Spira Care | EPO | 34762MO0590014 | No |
| Blue KC Choice Bronze 2 BlueSelect EPO with Spira Care | EPO | 94248KS0560008 | No |
| Blue KC Choice Silver 1 BlueSelect EPO with Spira Care | EPO | 34762MO0590004 | No |
| Blue KC Choice Silver 1 BlueSelect EPO with Spira Care | EPO | 94248KS0560004 | No |
| Blue KC Choice Silver BlueSelect Plus EPO with Spira Care | EPO | 34762MO0590002 | No |
| Blue KC Choice Silver BlueSelect Plus EPO with Spira Care | EPO | 94248KS0560002 | No |
| Blue KC Community Silver Preferred-Care Blue EPO | EPO | 34762MO0590009 | No |
| Blue KC First Bronze Preferred-Care Blue EPO | EPO | 34762MO0590010 | No |
| Blue KC Saver Bronze Preferred-Care Blue EPO | EPO | 34762MO0590003 | No |
| Blue KC Saver Bronze Preferred-Care Blue EPO | EPO | 94248KS0560009 | No |
| Blue KC Standard Bronze BlueSelect EPO | EPO | 34762MO0590018 | No |
| Blue KC Standard Bronze BlueSelect EPO | EPO | 94248KS0560015 | No |
| Blue KC Standard Bronze Preferred-Care Blue EPO | EPO | 34762MO0590020 | No |
| Blue KC Standard Gold Preferred-Care Blue EPO | EPO | 34762MO0590013 | No |
| Blue KC Standard Gold Preferred-Care Blue EPO | EPO | 94248KS0560007 | No |
| Blue KC Standard Silver BlueSelect EPO | EPO | 34762MO0590022 | No |
| Blue KC Standard Silver BlueSelect EPO | EPO | 94248KS0560014 | No |
| Blue KC Standard Silver Preferred-Care Blue EPO | EPO | 34762MO0590019 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Blue Focus Bronze POS? 205 | POS | 30751MT0670003 | No |
| Blue Focus Bronze POS? 205 | POS | 30751MT0670012 | No |
| Blue Focus Bronze POS? 205 | POS | 30751MT0670013 | No |
| Blue Focus Bronze POS? 705 | POS | 30751MT0670006 | No |
| Blue Focus Bronze POS? 705 | POS | 30751MT0670016 | No |
| Blue Focus Bronze POS? 705 | POS | 30751MT0670017 | No |
| Blue Focus Bronze POS? Standard | POS | 30751MT0670009 | No |
| Blue Focus Bronze POS? Standard | POS | 30751MT0670018 | No |
| Blue Focus Bronze POS? Standard | POS | 30751MT0670019 | No |
| Blue Focus Gold POS? 207 | POS | 30751MT0670001 | No |
| Blue Focus Gold POS? 207 | POS | 30751MT0670020 | No |
| Blue Focus Gold POS? 207 | POS | 30751MT0670021 | No |
| Blue Focus Gold POS? Standard | POS | 30751MT0670007 | No |
| Blue Focus Gold POS? Standard | POS | 30751MT0670022 | No |
| Blue Focus Gold POS? Standard | POS | 30751MT0670023 | No |
| Blue Focus Silver POS? 206 | POS | 30751MT0670002 | No |
| Blue Focus Silver POS? 206 | POS | 30751MT0670024 | No |
| Blue Focus Silver POS? 206 | POS | 30751MT0670025 | No |
| Blue Focus Silver POS? Standard | POS | 30751MT0670008 | No |
| Blue Focus Silver POS? Standard | POS | 30751MT0670028 | No |
| Blue Focus Silver POS? Standard | POS | 30751MT0670029 | No |
| Blue Preferred Bronze PPO? 201 | PPO | 30751MT0550040 | No |
| Blue Preferred Bronze PPO? 201 | PPO | 30751MT0550049 | No |
| Blue Preferred Bronze PPO? 201 | PPO | 30751MT0550050 | No |
| Blue Preferred Bronze PPO? 201 | PPO | 30751MT0550051 | No |
| Blue Preferred Bronze PPO? 202 | PPO | 30751MT0550041 | No |
| Blue Preferred Bronze PPO? 202 | PPO | 30751MT0550052 | No |
| Blue Preferred Bronze PPO? 202 | PPO | 30751MT0550053 | No |
| Blue Preferred Bronze PPO? 202 | PPO | 30751MT0550054 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 30751MT0550092 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 30751MT0550093 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 30751MT0550100 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 30751MT0550101 | No |
| Blue Preferred Gold PPO? 204 | PPO | 30751MT0550038 | No |
| Blue Preferred Gold PPO? 204 | PPO | 30751MT0550043 | No |
| Blue Preferred Gold PPO? 204 | PPO | 30751MT0550044 | No |
| Blue Preferred Gold PPO? 204 | PPO | 30751MT0550045 | No |
| Blue Preferred Gold PPO? Standard | PPO | 30751MT0550086 | No |
| Blue Preferred Gold PPO? Standard | PPO | 30751MT0550089 | No |
| Blue Preferred Gold PPO? Standard | PPO | 30751MT0550094 | No |
| Blue Preferred Gold PPO? Standard | PPO | 30751MT0550095 | No |
| Blue Preferred Security PPO? 200 | PPO | 30751MT0550042 | No |
| Blue Preferred Security PPO? 200 | PPO | 30751MT0550055 | No |
| Blue Preferred Security PPO? 200 | PPO | 30751MT0550056 | No |
| Blue Preferred Security PPO? 200 | PPO | 30751MT0550057 | No |
| Blue Preferred Silver PPO? 203 | PPO | 30751MT0550039 | No |
| Blue Preferred Silver PPO? 203 | PPO | 30751MT0550046 | No |
| Blue Preferred Silver PPO? 203 | PPO | 30751MT0550047 | No |
| Blue Preferred Silver PPO? 203 | PPO | 30751MT0550048 | No |
| Blue Preferred Silver PPO? 308 | PPO | 30751MT0550061 | No |
| Blue Preferred Silver PPO? 308 | PPO | 30751MT0550071 | No |
| Blue Preferred Silver PPO? 308 | PPO | 30751MT0550072 | No |
| Blue Preferred Silver PPO? 308 | PPO | 30751MT0550073 | No |
| Blue Preferred Silver PPO? Standard | PPO | 30751MT0550087 | No |
| Blue Preferred Silver PPO? Standard | PPO | 30751MT0550090 | No |
| Blue Preferred Silver PPO? Standard | PPO | 30751MT0550096 | No |
| Blue Preferred Silver PPO? Standard | PPO | 30751MT0550097 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue | EPO | 29678NE1450002 | No |
| HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO | PPO | 29678NE1510002 | No |
| HeartlandBlue Bronze 5000 Blueprint Health w/ Adult Vision | EPO | 29678NE1560014 | No |
| HeartlandBlue Bronze 5000 Blueprint Health w/ Adult Vision | EPO | 29678NE1570014 | No |
| HeartlandBlue Bronze 5000 Blueprint Health w/ Adult Vision | EPO | 29678NE1580014 | No |
| HeartlandBlue Bronze 5000 Premier Select BlueChoice w/ Adult Vision | EPO | 29678NE1530014 | No |
| HeartlandBlue Bronze 5000 Premier Select BlueChoice w/ Adult Vision | EPO | 29678NE1540014 | No |
| HeartlandBlue Bronze 5000 Premier Select BlueChoice w/ Adult Vision | EPO | 29678NE1550014 | No |
| HeartlandBlue Bronze HSA 6500 Blueprint Health | EPO | 29678NE1480001 | No |
| HeartlandBlue Bronze HSA 6500 Blueprint Health | EPO | 29678NE1490001 | No |
| HeartlandBlue Bronze HSA 6500 Blueprint Health | EPO | 29678NE1500001 | No |
| HeartlandBlue Bronze HSA 6500 NEtwork Blue | EPO | 29678NE1450001 | No |
| HeartlandBlue Bronze HSA 6500 NEtwork Blue PPO | PPO | 29678NE1510001 | No |
| HeartlandBlue Bronze HSA 6500 Premier Select BlueChoice | EPO | 29678NE1460001 | No |
| HeartlandBlue Bronze HSA 6500 Premier Select BlueChoice | EPO | 29678NE1470001 | No |
| HeartlandBlue Bronze HSA 6500 Premier Select BlueChoice | EPO | 29678NE1520001 | No |
| HeartlandBlue Bronze Standard 7500 Blueprint Health | EPO | 29678NE1480006 | No |
| HeartlandBlue Bronze Standard 7500 Blueprint Health | EPO | 29678NE1490006 | No |
| HeartlandBlue Bronze Standard 7500 Blueprint Health | EPO | 29678NE1500006 | No |
| HeartlandBlue Bronze Standard 7500 NEtwork Blue | EPO | 29678NE1450006 | No |
| HeartlandBlue Bronze Standard 7500 NEtwork Blue PPO | PPO | 29678NE1510006 | No |
| HeartlandBlue Bronze Standard 7500 Premier Select BlueChoice | EPO | 29678NE1460006 | No |
| HeartlandBlue Bronze Standard 7500 Premier Select BlueChoice | EPO | 29678NE1470006 | No |
| HeartlandBlue Bronze Standard 7500 Premier Select BlueChoice | EPO | 29678NE1520006 | No |
| HeartlandBlue Gold $0 Deductible NEtwork Blue | EPO | 29678NE1450012 | No |
| HeartlandBlue Gold $0 Deductible NEtwork Blue PPO | PPO | 29678NE1510012 | No |
| HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue | EPO | 29678NE1450011 | No |
| HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO | PPO | 29678NE1510011 | No |
| HeartlandBlue Gold Standard 1500 Blueprint Health | EPO | 29678NE1480013 | No |
| HeartlandBlue Gold Standard 1500 Blueprint Health | EPO | 29678NE1490013 | No |
| HeartlandBlue Gold Standard 1500 Blueprint Health | EPO | 29678NE1500013 | No |
| HeartlandBlue Gold Standard 1500 NEtwork Blue | EPO | 29678NE1450013 | No |
| HeartlandBlue Gold Standard 1500 NEtwork Blue PPO | PPO | 29678NE1510013 | No |
| HeartlandBlue Gold Standard 1500 Premier Select BlueChoice | EPO | 29678NE1460013 | No |
| HeartlandBlue Gold Standard 1500 Premier Select BlueChoice | EPO | 29678NE1470013 | No |
| HeartlandBlue Gold Standard 1500 Premier Select BlueChoice | EPO | 29678NE1520013 | No |
| HeartlandBlue Silver $0 Mental Health Visit 6000 NEtwork Blue | EPO | 29678NE1450009 | No |
| HeartlandBlue Silver $0 Mental Health Visit 6000 NEtwork Blue PPO | PPO | 29678NE1510009 | No |
| HeartlandBlue Silver $0 PCP Visit 4500 NEtwork Blue | EPO | 29678NE1450008 | No |
| HeartlandBlue Silver $0 PCP Visit 4500 NEtwork Blue PPO | PPO | 29678NE1510008 | No |
| HeartlandBlue Silver Standard 5000 Blueprint Health | EPO | 29678NE1480010 | No |
| HeartlandBlue Silver Standard 5000 Blueprint Health | EPO | 29678NE1490010 | No |
| HeartlandBlue Silver Standard 5000 Blueprint Health | EPO | 29678NE1500010 | No |
| HeartlandBlue Silver Standard 5000 NEtwork Blue | EPO | 29678NE1450010 | No |
| HeartlandBlue Silver Standard 5000 NEtwork Blue PPO | PPO | 29678NE1510010 | No |
| HeartlandBlue Silver Standard 5000 Premier Select BlueChoice | EPO | 29678NE1460010 | No |
| HeartlandBlue Silver Standard 5000 Premier Select BlueChoice | EPO | 29678NE1470010 | No |
| HeartlandBlue Silver Standard 5000 Premier Select BlueChoice | EPO | 29678NE1520010 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Blue Advantage Bronze PPO? 202 | PPO | 87571OK0350070 | No |
| Blue Advantage Bronze PPO? 202 | PPO | 87571OK0350091 | No |
| Blue Advantage Bronze PPO? 202 | PPO | 87571OK0350092 | No |
| Blue Advantage Bronze PPO? 202 | PPO | 87571OK0350093 | No |
| Blue Advantage Bronze PPO? 202 | PPO | 87571OK0350094 | No |
| Blue Advantage Bronze PPO? 203 | PPO | 87571OK0350068 | No |
| Blue Advantage Bronze PPO? 203 | PPO | 87571OK0350083 | No |
| Blue Advantage Bronze PPO? 203 | PPO | 87571OK0350084 | No |
| Blue Advantage Bronze PPO? 203 | PPO | 87571OK0350085 | No |
| Blue Advantage Bronze PPO? 203 | PPO | 87571OK0350086 | No |
| Blue Advantage Bronze PPO? Standard | PPO | 87571OK0350176 | No |
| Blue Advantage Bronze PPO? Standard | PPO | 87571OK0350219 | No |
| Blue Advantage Bronze PPO? Standard | PPO | 87571OK0350220 | No |
| Blue Advantage Bronze PPO? Standard | PPO | 87571OK0350221 | No |
| Blue Advantage Bronze PPO? Standard | PPO | 87571OK0350222 | No |
| Blue Advantage Gold PPO? 309 | PPO | 87571OK0350097 | No |
| Blue Advantage Gold PPO? 309 | PPO | 87571OK0350106 | No |
| Blue Advantage Gold PPO? 309 | PPO | 87571OK0350107 | No |
| Blue Advantage Gold PPO? 309 | PPO | 87571OK0350108 | No |
| Blue Advantage Gold PPO? 309 | PPO | 87571OK0350109 | No |
| Blue Advantage Gold PPO? 604 | PPO | 87571OK0350118 | No |
| Blue Advantage Gold PPO? 604 | PPO | 87571OK0350127 | No |
| Blue Advantage Gold PPO? 604 | PPO | 87571OK0350128 | No |
| Blue Advantage Gold PPO? 604 | PPO | 87571OK0350129 | No |
| Blue Advantage Gold PPO? 604 | PPO | 87571OK0350130 | No |
| Blue Advantage Gold PPO? Standard | PPO | 87571OK0350178 | No |
| Blue Advantage Gold PPO? Standard | PPO | 87571OK0350227 | No |
| Blue Advantage Gold PPO? Standard | PPO | 87571OK0350228 | No |
| Blue Advantage Gold PPO? Standard | PPO | 87571OK0350229 | No |
| Blue Advantage Gold PPO? Standard | PPO | 87571OK0350230 | No |
| Blue Advantage Silver PPO? 204 | PPO | 87571OK0350069 | No |
| Blue Advantage Silver PPO? 204 | PPO | 87571OK0350087 | No |
| Blue Advantage Silver PPO? 204 | PPO | 87571OK0350088 | No |
| Blue Advantage Silver PPO? 204 | PPO | 87571OK0350089 | No |
| Blue Advantage Silver PPO? 204 | PPO | 87571OK0350090 | No |
| Blue Advantage Silver PPO? 501 | PPO | 87571OK0350115 | No |
| Blue Advantage Silver PPO? Standard | PPO | 87571OK0350177 | No |
| Blue Advantage Silver PPO? Standard | PPO | 87571OK0350223 | No |
| Blue Advantage Silver PPO? Standard | PPO | 87571OK0350224 | No |
| Blue Advantage Silver PPO? Standard | PPO | 87571OK0350225 | No |
| Blue Advantage Silver PPO? Standard | PPO | 87571OK0350226 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 87571OK0350173 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 87571OK0350191 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 87571OK0350192 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 87571OK0350193 | No |
| Blue Preferred Bronze PPO? Standard | PPO | 87571OK0350194 | No |
| Blue Preferred Gold PPO? Standard | PPO | 87571OK0350171 | No |
| Blue Preferred Gold PPO? Standard | PPO | 87571OK0350199 | No |
| Blue Preferred Gold PPO? Standard | PPO | 87571OK0350200 | No |
| Blue Preferred Gold PPO? Standard | PPO | 87571OK0350201 | No |
| Blue Preferred Gold PPO? Standard | PPO | 87571OK0350202 | No |
| Blue Preferred Security PPO? 200 | PPO | 87571OK0350165 | No |
| Blue Preferred Security PPO? 200 | PPO | 87571OK0350203 | No |
| Blue Preferred Security PPO? 200 | PPO | 87571OK0350204 | No |
| Blue Preferred Security PPO? 200 | PPO | 87571OK0350205 | No |
| Blue Preferred Security PPO? 200 | PPO | 87571OK0350206 | No |
| Blue Preferred Silver PPO? Standard | PPO | 87571OK0350172 | No |
| Blue Preferred Silver PPO? Standard | PPO | 87571OK0350215 | No |
| Blue Preferred Silver PPO? Standard | PPO | 87571OK0350216 | No |
| Blue Preferred Silver PPO? Standard | PPO | 87571OK0350217 | No |
| Blue Preferred Silver PPO? Standard | PPO | 87571OK0350218 | No |
| MyBlue Gold HMO? 704 | HMO | 87571OK0510057 | No |
| MyBlue Gold HMO? 704 | HMO | 87571OK0510060 | No |
| MyBlue Gold HMO? 804 | HMO | 87571OK0510071 | No |
| MyBlue Gold HMO? 804 | HMO | 87571OK0510073 | No |
| MyBlue Gold HMO? Standard | HMO | 87571OK0510063 | No |
| MyBlue Gold HMO? Standard | HMO | 87571OK0510066 | No |
| MyBlue Silver HMO? 705 | HMO | 87571OK0510058 | No |
| MyBlue Silver HMO? 705 | HMO | 87571OK0510061 | No |
| MyBlue Silver HMO? 803 | HMO | 87571OK0510070 | No |
| MyBlue Silver HMO? 803 | HMO | 87571OK0510072 | No |
| MyBlue Silver HMO? Standard | HMO | 87571OK0510064 | No |
| MyBlue Silver HMO? Standard | HMO | 87571OK0510067 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460554 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460705 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460706 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460707 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460708 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460709 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460710 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460711 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460712 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460713 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460714 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460715 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460716 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460717 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460718 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460719 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460721 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460722 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460723 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460724 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460725 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460726 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460727 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460728 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460869 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0461073 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0461074 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460782 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460783 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460787 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460792 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460793 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460794 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460795 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460797 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460799 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460801 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460802 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460803 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460804 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460806 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460871 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0461076 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461033 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461034 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461035 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461036 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461037 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461038 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461039 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461040 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461041 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461042 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461043 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461044 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461045 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461046 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461047 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461048 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461049 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461050 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461051 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461052 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461053 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461054 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461055 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461056 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461057 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461058 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461079 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460548 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460555 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460556 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460557 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460558 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460559 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460560 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460561 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460562 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460563 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460564 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460565 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460566 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460567 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460568 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460569 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460571 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460572 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460573 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460574 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460575 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460576 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460577 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460578 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460863 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0461061 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0461062 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460809 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460814 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460819 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460820 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460821 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460822 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460824 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460826 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460828 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460829 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460830 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460831 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460833 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460860 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460865 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0461066 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460925 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460928 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460929 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460930 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460931 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460932 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460933 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460934 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460935 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460936 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460937 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460938 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460939 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460940 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460941 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460942 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460943 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460944 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460945 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460946 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460947 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460948 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460949 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460950 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460951 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460952 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460953 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870002 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870038 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870039 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870040 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870041 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870042 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870043 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870044 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870045 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870046 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870047 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870048 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870049 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870050 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870051 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870052 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870053 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870054 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870055 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870056 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870057 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870058 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870059 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870060 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870061 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870062 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870063 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870003 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870064 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870065 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870066 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870067 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870068 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870069 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870070 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870071 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870072 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870073 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870074 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870075 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870076 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870077 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870078 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870079 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870080 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870081 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870082 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870083 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870084 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870085 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870086 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870087 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870088 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870089 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870004 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870090 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870091 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870092 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870093 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870094 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870095 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870096 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870097 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870098 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870099 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870100 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870101 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870102 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870103 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870104 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870105 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870106 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870107 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870108 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870109 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870110 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870111 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870112 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870113 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870114 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870115 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870005 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870116 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870117 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870118 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870119 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870120 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870121 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870122 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870123 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870124 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870125 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870126 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870127 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870128 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870129 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870130 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870131 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870132 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870133 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870134 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870135 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870136 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870137 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870138 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870139 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870140 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870141 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870011 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870272 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870273 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870274 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870275 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870276 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870277 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870278 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870279 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870280 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870281 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870282 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870283 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870284 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870285 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870286 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870287 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870288 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870289 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870290 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870291 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870292 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870293 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870294 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870295 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870296 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870297 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870006 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870142 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870143 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870144 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870145 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870146 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870147 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870148 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870149 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870150 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870151 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870152 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870153 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870154 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870155 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870156 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870157 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870158 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870159 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870160 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870161 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870162 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870163 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870164 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870165 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870166 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870167 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870007 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870168 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870169 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870170 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870171 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870172 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870173 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870174 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870175 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870176 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870177 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870178 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870179 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870180 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870181 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870182 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870183 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870184 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870185 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870186 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870187 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870188 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870189 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870190 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870191 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870192 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870193 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870009 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870220 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870221 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870222 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870223 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870224 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870225 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870226 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870227 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870228 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870229 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870230 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870231 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870232 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870233 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870234 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870235 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870236 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870237 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870238 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870239 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870240 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870241 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870242 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870243 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870244 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870245 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870010 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870246 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870247 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870248 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870249 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870250 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870251 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870252 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870253 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870254 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870255 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870256 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870257 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870258 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870259 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870260 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870261 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870262 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870263 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870264 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870265 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870266 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870267 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870268 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870269 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870270 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870271 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460552 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460655 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460656 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460657 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460658 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460659 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460660 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460661 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460662 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460663 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460664 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460665 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460666 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460667 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460668 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460669 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460671 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460672 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460673 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460674 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460675 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460676 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460677 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460678 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460872 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0461077 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0461078 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460553 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460680 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460681 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460682 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460683 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460684 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460685 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460686 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460687 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460688 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460689 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460690 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460691 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460692 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460693 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460694 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460696 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460697 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460698 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460699 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460700 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460701 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460702 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460703 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460867 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0461069 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0461070 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461083 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461090 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461094 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461099 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461100 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461101 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461102 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461104 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461105 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461107 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461108 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461109 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461110 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461112 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461114 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461115 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460926 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460954 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460955 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460956 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460957 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460958 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460959 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460960 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460961 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460962 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460963 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460964 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460965 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460966 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460967 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460968 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460969 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460970 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460971 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460972 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460973 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460974 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460975 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460976 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460977 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460978 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460979 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461080 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461116 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461117 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461118 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461119 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461120 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461121 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461122 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461179 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461196 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461197 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461087 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461159 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461160 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461161 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461163 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461164 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461185 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461198 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461199 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461081 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461123 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461124 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461125 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461126 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461127 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461128 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461129 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461180 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461200 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461201 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461088 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461166 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461167 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461168 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461170 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461171 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461186 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461202 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461203 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461082 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461130 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461131 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461132 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461133 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461134 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461135 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461136 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461181 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461204 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461205 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461089 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461173 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461174 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461175 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461177 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461178 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461187 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461208 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461209 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| BlueCare Gold $25 PCP Copay ($5 Value Based Drug List) | PPO | 37160ND2410005 | No |
| BlueCare Silver $45 PCP Copay ($5 Value Based Drug List) | PPO | 37160ND2410002 | No |
| BlueDirect Bronze 100 HSA Eligible ($7500 Deductible / $5 Preventive Drug List) | PPO | 37160ND2410020 | No |
| BlueDirect Gold 90 HSA Eligible ($2600 Deductible / $5 Preventive Drug List) | PPO | 37160ND2410022 | No |
| BlueDirect Silver 80 HSA Eligible ($3500 Deductible / $5 Preventive Drug List) | PPO | 37160ND2410014 | No |
| BlueEssential Catastrophic 100 $9200 Deductible | PPO | 37160ND2410021 | No |
| BlueValue Bronze $50 PCP Copay (Standardized plan) | PPO | 37160ND2410028 | No |
| BlueValue Gold $30 PCP Copay (Standardized plan) | PPO | 37160ND2410026 | No |
| BlueValue Silver $40 PCP Copay (Standardized plan) | PPO | 37160ND2410027 | No |
| DakotaBlue Altru Gold ($5 Value Based Drug List) | PPO | 37160ND2480001 | No |
| DakotaBlue Altru Silver ($5 Value Based Drug List) | PPO | 37160ND2480003 | No |
| DakotaBlue Trinity Gold ($5 Value Based Drug List) | PPO | 37160ND2480009 | No |
| DakotaBlue Trinity Silver ($5 Value Based Drug List) | PPO | 37160ND2480010 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| BlueSelect Bronze Basic | PPO | 11269WY0070026 | No |
| BlueSelect Bronze Core | PPO | 11269WY0070004 | No |
| BlueSelect Expanded Bronze Standard without Kid's Dental | PPO | 11269WY0170020 | No |
| BlueSelect Gold Core | PPO | 11269WY0070025 | No |
| BlueSelect Gold HealthPlus | PPO | 11269WY0070013 | No |
| BlueSelect Gold Standard without Kid's Dental | PPO | 11269WY0170017 | No |
| BlueSelect Silver Classic | PPO | 11269WY0070014 | No |
| BlueSelect Silver Classic without Kid's Dental | PPO | 11269WY0170016 | No |
| BlueSelect Silver HealthPlus | PPO | 11269WY0070016 | No |
| BlueSelect Silver HealthPlus without Kid's Dental | PPO | 11269WY0170021 | No |
| BlueSelect Silver Standard without Kid's Dental | PPO | 11269WY0170018 | 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? |
|---|---|---|---|
| CGHC Bronze $0 Ded / $2250 Rx Ded - Envision Network | EPO | 87416WI0030003 | No |
| CGHC Bronze $0 Ded / $2250 Rx Ded - Envision Network (Vision Exam) | EPO | 87416WI0060023 | No |
| CGHC Bronze $9200 ($40 PCP Copay) - Envision Network | EPO | 87416WI0030027 | No |
| CGHC Bronze $9200 ($40 PCP Copay) - Envision Network (Vision Exam) | EPO | 87416WI0060015 | No |
| CGHC Bronze Standard $7500 - Envision Network | EPO | 87416WI0030041 | No |
| CGHC Catastrophic $9200 - Envision Network | EPO | 87416WI0030026 | No |
| CGHC Gold $0 Ded - Envision Network | EPO | 87416WI0030005 | No |
| CGHC Gold $0 Ded - Envision Network (Vision Exam) | EPO | 87416WI0060025 | No |
| CGHC Gold $3000 - Envision Network | EPO | 87416WI0030017 | No |
| CGHC Gold $3000 - Envision Network (Vision Exam) | EPO | 87416WI0060006 | No |
| CGHC Gold Standard $1500 - Envision Network | EPO | 87416WI0030043 | No |
| CGHC Silver $4200 Ded / $5000 Rx Ded - Envision Network | EPO | 87416WI0030023 | No |
| CGHC Silver $4200 Ded / $5000 Rx Ded - Envision Network (Vision Exam) | EPO | 87416WI0060012 | No |
| CGHC Silver $4700 Ded / $6000 Rx Ded - Envision Network | EPO | 87416WI0030047 | No |
| CGHC Silver $4700 Ded / $6000 Rx Ded - Envision Network (Vision Exam) | EPO | 87416WI0060011 | No |
| CGHC Silver Standard $5000 - Envision Network | EPO | 87416WI0030042 | 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? |
|---|---|---|---|
| BlueOptions Bronze (HSA) 24J01-10 (Rewards / $4 Condition Care Rx) | PPO | 16842FL0260010 | No |
| BlueOptions Bronze 24J01-04 ($0 Virtual PCP Visits / 3 PCP Visits for $0 then $55 / Rewards) | PPO | 16842FL0260004 | No |
| BlueOptions Bronze 24J01-06 ($0 Virtual PCP Visits / Rewards) | PPO | 16842FL0260006 | No |
| BlueOptions Bronze 24J01-17 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) | PPO | 16842FL0260017 | No |
| BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards) | PPO | 16842FL0260018 | No |
| BlueOptions Gold 24J01-09 ($0 Virtual PCP Visits / $15 PCP Visits / Rewards) | PPO | 16842FL0260009 | No |
| BlueOptions Gold 24J01-12 ($0 Virtual PCP Visits / $15 Labs / Rewards) | PPO | 16842FL0260012 | No |
| BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards) | PPO | 16842FL0260020 | No |
| BlueOptions Platinum 24J01-05 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) | PPO | 16842FL0260005 | No |
| BlueOptions Platinum 24J01-08 ($0 Virtual PCP Visits / $0 Labs / $10 PCP Visits / Rewards) | PPO | 16842FL0260008 | No |
| BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards) | PPO | 16842FL0260021 | No |
| BlueOptions Silver 24J01-03 ($0 Virtual PCP Visits / $0 Labs / Rewards) | PPO | 16842FL0260003 | No |
| BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) | PPO | 16842FL0260007 | No |
| BlueOptions Silver 24J01-19S ($40 PCP Visits / Multilingual Available / Rewards) | PPO | 16842FL0260019 | No |
| BlueSelect Bronze (HSA) 1735 (Rewards / $4 Condition Care Rx) | EPO | 16842FL0120078 | No |
| BlueSelect Bronze 1449 ($0 Virtual PCP Visits / 3 PCP Visits for $0 then $55 / Rewards) | EPO | 16842FL0120068 | No |
| BlueSelect Bronze 2139 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) | EPO | 16842FL0120091 | No |
| BlueSelect Bronze 2139E ($0 Virtual PCP Visits / $50 PCP Visits / Adult Dental & Vision / Rewards) | EPO | 16842FL0320014 | No |
| BlueSelect Bronze 2139V ($0 Virtual PCP Visits / $50 PCP Visits / Adult Vision / Rewards) | EPO | 16842FL0310014 | No |
| BlueSelect Bronze 2342S ($50 PCP Visits / Multilingual Available / Rewards) | EPO | 16842FL0120093 | No |
| BlueSelect Bronze 24L01-01 ($0 Virtual PCP Visits / Rewards) | EPO | 16842FL0120001 | No |
| BlueSelect Gold 1535 ($0 Virtual PCP Visits / $15 PCP Visits / Rewards) | EPO | 16842FL0120076 | No |
| BlueSelect Gold 1535V ($0 Virtual PCP Visits / $15 PCP Visits / Adult Vision / Rewards) | EPO | 16842FL0310001 | No |
| BlueSelect Gold 1835 ($0 Virtual PCP Visits / $15 Labs / Rewards) | EPO | 16842FL0120086 | No |
| BlueSelect Gold 2344S ($30 PCP Visits / Multilingual Available / Rewards) | EPO | 16842FL0120095 | No |
| BlueSelect Platinum 1451 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) | EPO | 16842FL0120062 | No |
| BlueSelect Platinum 1457 ($0 Deductible / $0 Virtual PCP Visits / $10 PCP Visits / Rewards) | EPO | 16842FL0120070 | No |
| BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards) | EPO | 16842FL0120096 | No |
| BlueSelect Silver 1443 ($0 Virtual PCP Visits / $0 Labs / Rewards) | EPO | 16842FL0120072 | No |
| BlueSelect Silver 1443E ($0 Virtual PCP Visits / $0 Labs / Adult Dental & Vision / Rewards) | EPO | 16842FL0320004 | No |
| BlueSelect Silver 1443V ($0 Virtual PCP Visits / $0 Labs / Adult Vision / Rewards) | EPO | 16842FL0310004 | No |
| BlueSelect Silver 1456 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) | EPO | 16842FL0120033 | No |
| BlueSelect Silver 2343S ($40 PCP Visits / Multilingual Available / Rewards) | EPO | 16842FL0120094 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| BlueCare Bronze (HSA) 24K01-09 (Rewards / $4 Condition Care Rx) | POS | 30252FL0140009 | No |
| BlueCare Bronze 24K01-03 ($0 Virtual PCP Visits / 3 PCP Visits for $0 then $55 / Rewards) | POS | 30252FL0140003 | No |
| BlueCare Bronze 24K01-05 ($0 Virtual PCP Visits / Rewards) | POS | 30252FL0140005 | No |
| BlueCare Bronze 24K01-25 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) | POS | 30252FL0140025 | No |
| BlueCare Bronze 24K01-31S (Multilingual Available / Rewards) | POS | 30252FL0140031 | No |
| BlueCare Bronze 24K02-17 ($0 Virtual PCP Visits / 3 PCP Visits for $0 then $55 / Rewards) | POS | 30252FL0140017 | No |
| BlueCare Bronze 24K02-18 ($0 Virtual PCP Visits / Rewards) | POS | 30252FL0140018 | No |
| BlueCare Bronze 24K02-23 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) | POS | 30252FL0140023 | No |
| BlueCare Bronze 24K02-26S (Multilingual Available / Rewards) | POS | 30252FL0140026 | No |
| BlueCare Gold 24K01-08 ($0 Virtual PCP Visits / $15 PCP Visits / Rewards) | POS | 30252FL0140008 | No |
| BlueCare Gold 24K01-10 ($0 Virtual PCP Visits / $15 Labs / Rewards) | POS | 30252FL0140010 | No |
| BlueCare Gold 24K01-33S ($30 PCP Visits / Multilingual Available/ Rewards) | POS | 30252FL0140033 | No |
| BlueCare Gold 24K02-20 ($0 Virtual PCP Visits / $15 PCP Visits / Rewards) | POS | 30252FL0140020 | No |
| BlueCare Gold 24K02-28S ($30 PCP Visits / Multilingual Available / Rewards) | POS | 30252FL0140028 | No |
| BlueCare Platinum 24K01-04 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) | POS | 30252FL0140004 | No |
| BlueCare Platinum 24K01-07 ($0 Virtual PCP Visits / $0 Labs / $10 PCP Visits / Rewards) | POS | 30252FL0140007 | No |
| BlueCare Platinum 24K01-34S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards) | POS | 30252FL0140034 | No |
| BlueCare Platinum 24K02-15 ($0 Virtual PCP Visits / $0 Labs / $10 PCP Visits / Rewards) | POS | 30252FL0140015 | No |
| BlueCare Platinum 24K02-29S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards) | POS | 30252FL0140029 | No |
| BlueCare Silver 24K01-02 ($0 Virtual PCP Visits / $0 Labs / Rewards) | POS | 30252FL0140002 | No |
| BlueCare Silver 24K01-06 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) | POS | 30252FL0140006 | No |
| BlueCare Silver 24K01-32S ($40 PCP Visits / Multilingual Available / Rewards) | POS | 30252FL0140032 | No |
| BlueCare Silver 24K02-21 ($0 Virtual PCP Visits / $0 Labs / Rewards) | POS | 30252FL0140021 | No |
| BlueCare Silver 24K02-27S ($40 PCP Visits / Multilingual Available / Rewards) | POS | 30252FL0140027 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Humana Dental Smart Choice | PPO | 44965LA0590001 | Yes |
| Humana Dental Smart Choice | PPO | 62294MI0420001 | Yes |
| Humana Dental Smart Choice | PPO | 91604WI0490002 | Yes |
| Humana Dental Smart Choice | PPO | 97596OH0580003 | Yes |
| Humana Dental Smart Choice - High | PPO | 15980FL0160004 | Yes |
| Humana Dental Smart Choice - High | PPO | 31358HI0010002 | Yes |
| Humana Dental Smart Choice - High | PPO | 48963MS0510003 | Yes |
| Humana Dental Smart Choice - High | PPO | 63141TX0760002 | Yes |
| Humana Dental Smart Choice - High | PPO | 66105AZ0620003 | Yes |
| Humana Dental Smart Choice - High | PPO | 82120TN0630005 | Yes |
| Humana Dental Smart Choice - High | PPO | 99791IN0540002 | Yes |
| Humana Dental Smart Choice - Lite | PPO | 15980FL0160005 | Yes |
| Humana Dental Smart Choice - Lite | PPO | 30613MO0560002 | Yes |
| Humana Dental Smart Choice - Lite | PPO | 32237NC0290003 | Yes |
| Humana Dental Smart Choice - Lite | PPO | 44580AL0380004 | Yes |
| Humana Dental Smart Choice - Lite | PPO | 63141TX0760003 | Yes |
| Humana Dental Smart Choice - Low | PPO | 15980FL0160003 | Yes |
| Humana Dental Smart Choice - Low | PPO | 32237NC0290001 | Yes |
| Humana Dental Smart Choice - Low | PPO | 44580AL0380001 | Yes |
| Humana Dental Smart Choice - Low | PPO | 48963MS0510002 | Yes |
| Humana Dental Smart Choice - Low | PPO | 63141TX0760001 | Yes |
| Humana Dental Smart Choice - Low | PPO | 82120TN0630004 | Yes |
| Humana Dental Smart Choice - Low | PPO | 99791IN0540001 | Yes |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| 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? |
|---|---|---|---|
| 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? |
|---|---|---|---|
| Sanford Individual Simplicity $1,750 | PPO | 31195SD0110001 | No |
| Sanford Individual Simplicity $1,750 | PPO | 89364ND0120001 | No |
| Sanford Individual Simplicity $3,500 | PPO | 31195SD0110003 | No |
| Sanford Individual Simplicity $3,500 | PPO | 89364ND0120003 | No |
| Sanford Individual Simplicity $4,750 | PPO | 31195SD0110005 | No |
| Sanford Individual Simplicity $4,750 | PPO | 89364ND0120005 | No |
| Sanford Individual Simplicity $6,000 | PPO | 31195SD0110007 | No |
| Sanford Individual Simplicity $6,000 | PPO | 89364ND0120007 | No |
| Sanford Individual Simplicity $7,100 HSA Qualified | PPO | 31195SD0110006 | No |
| Sanford Individual Simplicity $7,100 HSA Qualified | PPO | 89364ND0120006 | No |
| Sanford Individual Simplicity $9,200 | PPO | 31195SD0110009 | No |
| Sanford Individual Simplicity $9,200 | PPO | 89364ND0120009 | No |
| Sanford Individual Simplicity Standardized $1,500 | PPO | 31195SD0110018 | No |
| Sanford Individual Simplicity Standardized $1,500 | PPO | 89364ND0120018 | No |
| Sanford Individual Simplicity Standardized $5,000 | PPO | 31195SD0110017 | No |
| Sanford Individual Simplicity Standardized $5,000 | PPO | 89364ND0120017 | No |
| Sanford Individual Simplicity Standardized $7,500 | PPO | 31195SD0110016 | No |
| Sanford Individual Simplicity Standardized $7,500 | PPO | 89364ND0120016 | No |
| Sanford Individual TRUE $1,750 | HMO | 31195SD0080018 | No |
| Sanford Individual TRUE $1,750 | HMO | 89364ND0090018 | No |
| Sanford Individual TRUE $3,500 | HMO | 31195SD0080008 | No |
| Sanford Individual TRUE $3,500 | HMO | 89364ND0090008 | No |
| Sanford Individual TRUE $4,750 | HMO | 31195SD0080016 | No |
| Sanford Individual TRUE $4,750 | HMO | 89364ND0090016 | No |
| Sanford Individual TRUE $6,000 | HMO | 31195SD0080007 | No |
| Sanford Individual TRUE $6,000 | HMO | 89364ND0090007 | No |
| Sanford Individual TRUE $7,100 HSA Qualified | HMO | 31195SD0080009 | No |
| Sanford Individual TRUE $7,100 HSA Qualified | HMO | 89364ND0090009 | No |
| Sanford Individual TRUE $9,200 | HMO | 31195SD0080015 | No |
| Sanford Individual TRUE $9,200 | HMO | 89364ND0090015 | No |
| Sanford Individual TRUE Standardized $1,500 | HMO | 31195SD0080028 | No |
| Sanford Individual TRUE Standardized $1,500 | HMO | 89364ND0090028 | No |
| Sanford Individual TRUE Standardized $5,000 | HMO | 31195SD0080027 | No |
| Sanford Individual TRUE Standardized $5,000 | HMO | 89364ND0090027 | No |
| Sanford Individual TRUE Standardized $7,500 | HMO | 31195SD0080026 | No |
| Sanford Individual TRUE Standardized $7,500 | HMO | 89364ND0090026 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| UHC Bronze Copay Focus $0 Indiv Med Ded | HMO | 33764SC0030012 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) | HMO | 40220TX0080031 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) | HMO | 40702AZ0060034 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) | HMO | 68398FL0030045 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | EPO | 69461AL0110020 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | EPO | 69842LA0240024 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | EPO | 94968KS0090015 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | EPO | 95426MO0410019 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | HMO | 33931OH0030035 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | HMO | 45480OK0050035 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | HMO | 54332NC0030033 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | HMO | 80180WI0100004 | No |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | HMO | 97560MS0030028 | No |
| UHC Bronze Copay Focus (No Referrals) | EPO | 69443TN0140028 | No |
| UHC Bronze Copay Focus (No Referrals) | HMO | 42529IL0070023 | No |
| UHC Bronze Copay Focus (No Referrals) | HMO | 71667MI0010039 | No |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision) | HMO | 40702AZ0070005 | No |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | EPO | 94968KS0100004 | No |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | HMO | 33931OH0070004 | No |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | HMO | 80180WI0110003 | No |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | HMO | 97560MS0080006 | No |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded (Dental + Vision) | HMO | 33764SC0040002 | No |
| UHC Bronze Copay Focus+ (Dental + Vision, No Referrals) | EPO | 69443TN0180003 | No |
| UHC Bronze Standard | HMO | 33764SC0030008 | No |
| UHC Bronze Standard | HMO | 40220TX0080015 | No |
| UHC Bronze Standard | HMO | 40702AZ0060019 | No |
| UHC Bronze Standard | HMO | 68398FL0030042 | No |
| UHC Bronze Standard (No Referrals) | EPO | 69443TN0140025 | No |
| UHC Bronze Standard (No Referrals) | EPO | 69461AL0110018 | No |
| UHC Bronze Standard (No Referrals) | EPO | 69842LA0240018 | No |
| UHC Bronze Standard (No Referrals) | EPO | 94968KS0090013 | No |
| UHC Bronze Standard (No Referrals) | EPO | 95426MO0410013 | No |
| UHC Bronze Standard (No Referrals) | HMO | 33931OH0030026 | No |
| UHC Bronze Standard (No Referrals) | HMO | 42529IL0070021 | No |
| UHC Bronze Standard (No Referrals) | HMO | 45480OK0050030 | No |
| UHC Bronze Standard (No Referrals) | HMO | 54332NC0030030 | No |
| UHC Bronze Standard (No Referrals) | HMO | 71667MI0010030 | No |
| UHC Bronze Standard (No Referrals) | HMO | 80180WI0100001 | No |
| UHC Bronze Standard (No Referrals) | HMO | 97560MS0030025 | No |
| UHC Bronze Standard+ (Dental + Vision, No Referrals) | HMO | 33931OH0070005 | No |
| UHC Bronze Value | HMO | 33764SC0030009 | No |
| UHC Bronze Value ($0 Virtual Urgent Care) | HMO | 40702AZ0060033 | No |
| UHC Bronze Value ($0 Virtual Urgent Care) | HMO | 68398FL0030041 | No |
| UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 40220TX0080010 | No |
| UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 95426MO0410011 | No |
| UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 54332NC0030032 | No |
| UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 97560MS0030023 | No |
| UHC Bronze Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals) | EPO | 69461AL0110007 | No |
| UHC Bronze Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals) | EPO | 94968KS0090011 | No |
| UHC Bronze Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals) | HMO | 45480OK0050017 | No |
| UHC Bronze Value ($5 Tier 2 Rx, No Referrals) | EPO | 69842LA0240008 | No |
| UHC Bronze Value ($5 Tier 2 Rx, No Referrals) | HMO | 33931OH0030034 | No |
| UHC Bronze Value (No Referrals) | EPO | 69443TN0140007 | No |
| UHC Bronze Value (No Referrals) | HMO | 71667MI0010012 | No |
| UHC Bronze Value (Rx Copay, No Referrals) | HMO | 42529IL0070018 | No |
| UHC Bronze Value HSA (No Referrals) | HMO | 80180WI0100003 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) | HMO | 40220TX0090003 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 95426MO0420003 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 54332NC0060003 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 97560MS0080005 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 69461AL0120003 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 69842LA0250004 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 94968KS0100003 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 45480OK0110003 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, Dental + Vision) | HMO | 40702AZ0070004 | No |
| UHC Bronze Value+ ($0 Virtual Urgent Care, Dental + Vision) | HMO | 68398FL0060003 | No |
| UHC Bronze Value+ ($5 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 33931OH0070003 | No |
| UHC Bronze Value+ (Dental + Vision, No Referrals) | HMO | 71667MI0050003 | No |
| UHC Bronze Value+ (Rx Copay, Dental + Vision, No Referrals) | HMO | 42529IL0080003 | No |
| UHC Gold Advantage | HMO | 33764SC0030001 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx) | HMO | 68398FL0030057 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | HMO | 54332NC0030015 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 40220TX0080028 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 40702AZ0060046 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 69461AL0110025 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 94968KS0090019 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 95426MO0410020 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 80180WI0100002 | No |
| UHC Gold Advantage ($0 Virtual Urgent Care, No Referrals) | HMO | 45480OK0050038 | No |
| UHC Gold Advantage ($3 Tier 2 Rx, No Referrals) | HMO | 33931OH0030042 | No |
| UHC Gold Advantage ($5 Tier 2 Rx, No Referrals) | EPO | 69842LA0240025 | No |
| UHC Gold Advantage (No Referrals) | EPO | 69443TN0140031 | No |
| UHC Gold Advantage (No Referrals) | HMO | 42529IL0070029 | No |
| UHC Gold Advantage (No Referrals) | HMO | 71667MI0010024 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision) | HMO | 68398FL0060001 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 54332NC0060002 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) | HMO | 40220TX0090002 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) | HMO | 40702AZ0070010 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 69461AL0120002 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 94968KS0100001 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 95426MO0420001 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 80180WI0110002 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 69842LA0250002 | No |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | HMO | 45480OK0110001 | No |
| UHC Gold Advantage+ ($3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 33931OH0070002 | No |
| UHC Gold Advantage+ (Dental + Vision) | HMO | 33764SC0040001 | No |
| UHC Gold Advantage+ (Dental + Vision, No Referrals) | EPO | 69443TN0180002 | No |
| UHC Gold Advantage+ (Dental + Vision, No Referrals) | HMO | 42529IL0080005 | No |
| UHC Gold Advantage+ (Dental + Vision, No Referrals) | HMO | 71667MI0050002 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded | HMO | 33764SC0030003 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | HMO | 97560MS0030032 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 40702AZ0060047 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 68398FL0030034 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin, No Referrals) | EPO | 69842LA0240023 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 69461AL0110023 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 94968KS0090018 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 95426MO0410018 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 33931OH0030032 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 54332NC0030035 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 80180WI0100012 | No |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals) | HMO | 45480OK0050034 | No |
| UHC Gold Copay Focus (No Referrals) | EPO | 69443TN0140030 | No |
| UHC Gold Copay Focus (No Referrals) | HMO | 42529IL0070027 | No |
| UHC Gold Copay Focus (No Referrals) | HMO | 71667MI0010042 | No |
| UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 97560MS0080003 | No |
| UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 94968KS0100006 | No |
| UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 33931OH0070008 | No |
| UHC Gold Standard | HMO | 33764SC0030002 | No |
| UHC Gold Standard | HMO | 40220TX0080024 | No |
| UHC Gold Standard | HMO | 40702AZ0060016 | No |
| UHC Gold Standard | HMO | 68398FL0030036 | No |
| UHC Gold Standard $0 Indiv Ded ($0 Virtual Urgent Care) | HMO | 40220TX0080013 | No |
| UHC Gold Standard (No Referrals) | EPO | 69443TN0140016 | No |
| UHC Gold Standard (No Referrals) | EPO | 69461AL0110010 | No |
| UHC Gold Standard (No Referrals) | EPO | 69842LA0240012 | No |
| UHC Gold Standard (No Referrals) | EPO | 94968KS0090003 | No |
| UHC Gold Standard (No Referrals) | EPO | 95426MO0410009 | No |
| UHC Gold Standard (No Referrals) | HMO | 33931OH0030014 | No |
| UHC Gold Standard (No Referrals) | HMO | 45480OK0050028 | No |
| UHC Gold Standard (No Referrals) | HMO | 54332NC0030022 | No |
| UHC Gold Standard (No Referrals) | HMO | 71667MI0010026 | No |
| UHC Gold Standard (No Referrals) | HMO | 80180WI0100010 | No |
| UHC Gold Standard (No Referrals) | HMO | 97560MS0030014 | No |
| UHC Gold Standard (Rx Copay, No Referrals) | HMO | 42529IL0070012 | No |
| UHC Gold Standard+ (Dental + Vision, No Referrals) | HMO | 33931OH0070009 | No |
| UHC Gold Value ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | HMO | 97560MS0030031 | No |
| UHC Gold Value+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 97560MS0080004 | No |
| UHC Kelsey-Seybold Bronze Copay Focus | HMO | 40220TX0080032 | No |
| UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx) | HMO | 40220TX0080034 | No |
| UHC Kelsey-Seybold Silver Copay Focus | HMO | 40220TX0080033 | No |
| UHC Silver Advantage | HMO | 33764SC0030007 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx) | HMO | 68398FL0030048 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 40220TX0080026 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 40702AZ0060038 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 94968KS0090016 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 95426MO0410016 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 33931OH0030031 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 54332NC0030034 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 80180WI0100009 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 97560MS0030029 | No |
| UHC Silver Advantage ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals) | HMO | 45480OK0050037 | No |
| UHC Silver Advantage (No Referrals) | EPO | 69443TN0140029 | No |
| UHC Silver Advantage (No Referrals) | HMO | 71667MI0010041 | No |
| UHC Silver Advantage (Rx Copay, No Referrals) | HMO | 42529IL0070025 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision) | HMO | 68398FL0060002 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) | HMO | 40220TX0090001 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) | HMO | 40702AZ0070006 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 94968KS0100002 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 95426MO0420002 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 33931OH0070001 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 54332NC0060001 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 80180WI0110001 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 97560MS0080001 | No |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 45480OK0110002 | No |
| UHC Silver Advantage+ (Dental + Vision) | HMO | 33764SC0040003 | No |
| UHC Silver Advantage+ (Dental + Vision, No Referrals) | EPO | 69443TN0180001 | No |
| UHC Silver Advantage+ (Dental + Vision, No Referrals) | HMO | 71667MI0050001 | No |
| UHC Silver Advantage+ (Rx Copay, Dental + Vision, No Referrals) | HMO | 42529IL0080001 | No |
| UHC Silver Copay Focus $0 Indiv Med Ded | HMO | 33764SC0030006 | No |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) | HMO | 40702AZ0060041 | No |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | EPO | 69461AL0110013 | No |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | EPO | 69842LA0240022 | No |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | EPO | 95426MO0410006 | No |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | HMO | 33931OH0030030 | No |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | HMO | 97560MS0030018 | No |
| UHC Silver Copay Focus (No Referrals) | EPO | 69443TN0140020 | No |
| UHC Silver Copay Focus (No Referrals) | HMO | 42529IL0070013 | No |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision) | HMO | 40702AZ0070008 | No |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | EPO | 69461AL0120005 | No |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | EPO | 69842LA0250003 | No |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | HMO | 33931OH0070007 | No |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | HMO | 97560MS0080002 | No |
| UHC Silver Standard | EPO | 69842LA0240017 | No |
| UHC Silver Standard | HMO | 33764SC0030004 | No |
| UHC Silver Standard | HMO | 40220TX0080020 | No |
| UHC Silver Standard | HMO | 40702AZ0060018 | No |
| UHC Silver Standard | HMO | 68398FL0030040 | No |
| UHC Silver Standard (No Referrals) | EPO | 69443TN0140021 | No |
| UHC Silver Standard (No Referrals) | EPO | 69461AL0110014 | No |
| UHC Silver Standard (No Referrals) | EPO | 94968KS0090008 | No |
| UHC Silver Standard (No Referrals) | EPO | 95426MO0410008 | No |
| UHC Silver Standard (No Referrals) | HMO | 33931OH0030021 | No |
| UHC Silver Standard (No Referrals) | HMO | 42529IL0070017 | No |
| UHC Silver Standard (No Referrals) | HMO | 45480OK0050029 | No |
| UHC Silver Standard (No Referrals) | HMO | 54332NC0030027 | No |
| UHC Silver Standard (No Referrals) | HMO | 71667MI0010028 | No |
| UHC Silver Standard (No Referrals) | HMO | 80180WI0100005 | No |
| UHC Silver Standard (No Referrals) | HMO | 97560MS0030021 | No |
| UHC Silver Standard+ (Dental + Vision) | HMO | 68398FL0060005 | No |
| UHC Silver Standard+ (Dental + Vision, No Referrals) | EPO | 95426MO0420004 | No |
| UHC Silver Standard+ (Dental + Vision, No Referrals) | HMO | 33931OH0070006 | No |
| UHC Silver Standard+ (Dental + Vision, No Referrals) | HMO | 42529IL0080004 | No |
| UHC Silver Value ($0 Virtual Urgent Care, $2 Tier 2 Rx, No Referrals) | EPO | 69461AL0110004 | No |
| UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 40220TX0080025 | No |
| UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx) | HMO | 68398FL0030046 | No |
| UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 69842LA0240014 | No |
| UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | EPO | 94968KS0090004 | No |
| UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 45480OK0050036 | No |
| UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 54332NC0030020 | No |
| UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | HMO | 80180WI0100008 | No |
| UHC Silver Value (No Referrals) | HMO | 71667MI0010033 | No |
| UHC Silver Value+ ($0 Virtual Urgent Care, $2 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 69461AL0120004 | No |
| UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) | HMO | 40220TX0090004 | No |
| UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) | HMO | 68398FL0060004 | No |
| UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 69842LA0250005 | No |
| UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | EPO | 94968KS0100005 | No |
| UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 45480OK0110004 | No |
| UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 54332NC0060004 | No |
| UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | HMO | 80180WI0110004 | No |
| UHC Silver Value+ (Dental + Vision, No Referrals) | HMO | 71667MI0050004 | No |