WAL-MART STORES TEXAS LLC
Accepted Insurance Health Plans for NPI 1720005903
Pharmacy - Community/Retail Pharmacy in Rockport, TX
NPI Status: Active since July 16, 2006
- Aetna CVS Health
- Ambetter from Absolute Total Care
- Ambetter from Arizona Complete Health
- Ambetter from Arkansas Health & Wellness
- Ambetter from Home State Health
- Ambetter from Louisiana Healthcare Connections
- Ambetter from Magnolia Health
- Ambetter from Meridian
- Ambetter from Nebraska Total Care
- Ambetter from NH Healthy Families
- Ambetter from Sunflower Health Plan
- Ambetter from Superior HealthPlan
- Ambetter Health
- Ambetter Health of Delaware
- Ambetter of Alabama
- Ambetter of Illinois
- Ambetter of North Carolina
- Ambetter of Oklahoma
- Ambetter of Tennessee
- Antidote Health Plan of Arizona, Inc.
- Antidote Health Plan of Ohio, Inc.
- Arkansas Blue Cross and Blue Shield
- Avera Health Plans
- AvMed
- 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 Louisiana
- 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
- Chorus Community Health Plans
- CHRISTUS Health Plan
- Cigna Healthcare
- Common Ground Healthcare Cooperative
- Dean Health Plan
- Florida Blue (BlueCross BlueShield FL)
- Florida Blue HMO (a BlueCross BlueShield FL company)
- Health Advantage
- HealthPartners
- Highmark Blue Cross Blue Shield Delaware
- Highmark Blue Cross Blue Shield West Virginia
- HMO Louisiana
- Humana
- Medica
- MedMutual
- Moda Health Plan, Inc.
- Octave
- 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
- Primewell Health Services of Mississippi
- Priority Health
- Sanford Health Plan
- Sendero Health Plans, Local Nonprofit
- SummaCare
- UnitedHealthcare
- University of Michigan Health Plan
- WellCare of North Carolina
Accepted Health Plans and Insurance Coverage
List of insurance companies accepted by WAL-MART STORES TEXAS LLC. 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? |
|---|---|---|---|
| Clear Silver | HMO | 79222SC0010023 | No |
| Elite Bronze | HMO | 79222SC0010022 | No |
| Elite Bronze + Vision + Adult Dental | HMO | 79222SC0020022 | No |
| Elite Gold | HMO | 79222SC0010029 | No |
| Elite Gold + Vision + Adult Dental | HMO | 79222SC0020030 | No |
| Everyday Bronze | HMO | 79222SC0010011 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 79222SC0020011 | No |
| Everyday Gold | HMO | 79222SC0010026 | No |
| Everyday Gold + Vision + Adult Dental | HMO | 79222SC0020026 | No |
| Focused Silver | HMO | 79222SC0010025 | No |
| Focused Silver + Vision + Adult Dental | HMO | 79222SC0020025 | No |
| Standard Expanded Bronze | HMO | 79222SC0010031 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 79222SC0020031 | No |
| Standard Gold | HMO | 79222SC0010033 | No |
| Standard Gold + Vision + Adult Dental | HMO | 79222SC0020033 | No |
| Standard Silver | HMO | 79222SC0010032 | No |
| Standard Silver + Vision + Adult Dental | HMO | 79222SC0020032 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Choice Bronze HSA | HMO | 91450AZ0080037 | No |
| Choice Bronze HSA + Vision + Adult Dental | HMO | 91450AZ0180037 | No |
| Clear Silver | HMO | 91450AZ0080097 | No |
| Complete Gold | HMO | 91450AZ0080059 | No |
| Complete Gold + Vision + Adult Dental | HMO | 91450AZ0180059 | No |
| Complete Silver | HMO | 91450AZ0080044 | No |
| Complete Silver + Vision + Adult Dental | HMO | 91450AZ0180044 | No |
| Elite Gold | HMO | 91450AZ0080113 | No |
| Elite Gold + Vision + Adult Dental | HMO | 91450AZ0180113 | No |
| Everyday Bronze | HMO | 91450AZ0080119 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 91450AZ0180119 | No |
| Standard Expanded Bronze | HMO | 91450AZ0080122 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 91450AZ0180104 | No |
| Standard Gold | HMO | 91450AZ0080124 | No |
| Standard Gold + Vision + Adult Dental | HMO | 91450AZ0180106 | No |
| Standard Silver | HMO | 91450AZ0080123 | No |
| Standard Silver + Vision + Adult Dental | HMO | 91450AZ0180105 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Choice Bronze HSA (QualChoice) | POS | 70525AR0070285 | No |
| Complete Gold | PPO | 62141AR0080014 | No |
| Complete Gold + Vision + Adult Dental | PPO | 62141AR0100014 | No |
| Complete Silver (QualChoice) | POS | 70525AR0070001 | No |
| Connected Silver | PPO | 62141AR0080007 | No |
| Connected Silver (QualChoice) | POS | 70525AR0070261 | No |
| Connected Silver (QualChoiceLife) | PPO | 37903AR0070025 | No |
| Connected Silver + Vision + Adult Dental | PPO | 62141AR0100007 | No |
| Elite Bronze | PPO | 62141AR0080026 | No |
| Elite Bronze + Vision + Adult Dental | PPO | 62141AR0100026 | No |
| Elite Gold (QualChoice) | POS | 70525AR0070268 | No |
| Elite Gold (QualChoiceLife) | PPO | 37903AR0070031 | No |
| Everyday Bronze | PPO | 62141AR0080017 | No |
| Everyday Bronze + Vision + Adult Dental | PPO | 62141AR0100017 | No |
| Everyday Gold | PPO | 62141AR0080030 | No |
| Everyday Gold + Vision + Adult Dental | PPO | 62141AR0100030 | No |
| Everyday Silver (QualChoiceLife) | PPO | 37903AR0070001 | No |
| Focused Silver | PPO | 62141AR0080029 | No |
| Focused Silver + Vision + Adult Dental | PPO | 62141AR0100032 | No |
| Standard Expanded Bronze | PPO | 62141AR0080032 | No |
| Standard Expanded Bronze (QualChoice) | POS | 70525AR0070287 | No |
| Standard Expanded Bronze + Vision + Adult Dental | PPO | 62141AR0100033 | No |
| Standard Gold | PPO | 62141AR0080034 | No |
| Standard Gold (QualChoice) | POS | 70525AR0070289 | No |
| Standard Gold (QualChoiceLife) | PPO | 37903AR0070034 | No |
| Standard Gold + Vision + Adult Dental | PPO | 62141AR0100035 | No |
| Standard Silver | PPO | 62141AR0080033 | No |
| Standard Silver (QualChoice) | POS | 70525AR0070288 | No |
| Standard Silver (QualChoiceLife) | PPO | 37903AR0070033 | No |
| Standard Silver + Vision + Adult Dental | PPO | 62141AR0100034 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Complete Gold | EPO | 99723MO0090016 | No |
| Complete Gold + Vision + Adult Dental | EPO | 99723MO0110010 | No |
| Complete Silver | EPO | 99723MO0090011 | No |
| Complete Silver + Vision + Adult Dental | EPO | 99723MO0110013 | No |
| Elite Bronze | EPO | 99723MO0090053 | No |
| Elite Bronze + Vision + Adult Dental | EPO | 99723MO0110053 | No |
| Everyday Bronze | EPO | 99723MO0090018 | No |
| Everyday Bronze + Vision + Adult Dental | EPO | 99723MO0110009 | No |
| Everyday Gold | EPO | 99723MO0090063 | No |
| Everyday Gold + Vision + Adult Dental | EPO | 99723MO0110063 | No |
| Premier Silver | EPO | 99723MO0090004 | No |
| Premier Silver + Vision + Adult Dental | EPO | 99723MO0110014 | No |
| Standard Expanded Bronze | EPO | 99723MO0090069 | No |
| Standard Expanded Bronze + Vision + Adult Dental | EPO | 99723MO0110070 | No |
| Standard Gold | EPO | 99723MO0090071 | No |
| Standard Gold + Vision + Adult Dental | EPO | 99723MO0110072 | No |
| Standard Silver | EPO | 99723MO0090070 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Complete Gold | EPO | 90787LA0010006 | No |
| Complete Gold + Vision + Adult Dental | EPO | 90787LA0020005 | No |
| Elite Bronze | EPO | 90787LA0010002 | No |
| Elite Bronze + Vision + Adult Dental | EPO | 90787LA0020002 | No |
| Elite Gold | EPO | 90787LA0010008 | No |
| Elite Gold + Vision + Adult Dental | EPO | 90787LA0020008 | No |
| Elite Silver | EPO | 90787LA0010012 | No |
| Elite Silver + Vision + Adult Dental | EPO | 90787LA0020012 | No |
| Everyday Bronze | EPO | 90787LA0010001 | No |
| Everyday Bronze + Vision + Adult Dental | EPO | 90787LA0020001 | No |
| Focused Silver | EPO | 90787LA0010005 | No |
| Focused Silver + Vision + Adult Dental | EPO | 90787LA0020004 | No |
| Standard Expanded Bronze | EPO | 90787LA0010009 | No |
| Standard Expanded Bronze + Vision + Adult Dental | EPO | 90787LA0020009 | No |
| Standard Gold | EPO | 90787LA0010011 | No |
| Standard Gold + Vision + Adult Dental | EPO | 90787LA0020011 | No |
| Standard Silver | EPO | 90787LA0010010 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Choice Bronze HSA | HMO | 90714MS0010052 | No |
| Choice Bronze HSA + Vision + Adult Dental | HMO | 90714MS0030052 | No |
| Complete Gold | HMO | 90714MS0010019 | No |
| Complete Gold + Vision + Adult Dental | HMO | 90714MS0030019 | No |
| Complete Silver | HMO | 90714MS0010011 | No |
| Complete Silver + Vision + Adult Dental | HMO | 90714MS0030026 | No |
| Everyday Bronze | HMO | 90714MS0010016 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 90714MS0030010 | No |
| Everyday Gold | HMO | 90714MS0010060 | No |
| Everyday Gold + Vision + Adult Dental | HMO | 90714MS0030060 | No |
| Focused Silver | HMO | 90714MS0010059 | No |
| Focused Silver + Vision + Adult Dental | HMO | 90714MS0030059 | No |
| Standard Expanded Bronze | HMO | 90714MS0010063 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 90714MS0030064 | No |
| Standard Gold | HMO | 90714MS0010065 | No |
| Standard Gold + Vision + Adult Dental | HMO | 90714MS0030066 | No |
| Standard Silver | HMO | 90714MS0010064 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Clear Silver | HMO | 58594MI0030017 | No |
| Elite Bronze | HMO | 58594MI0030016 | No |
| Elite Bronze + Vision + Adult Dental | HMO | 58594MI0040016 | No |
| Elite Gold | HMO | 58594MI0030021 | No |
| Elite Gold + Vision + Adult Dental | HMO | 58594MI0040023 | No |
| Everyday Bronze | HMO | 58594MI0030013 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 58594MI0040013 | No |
| Everyday Gold | HMO | 58594MI0030020 | No |
| Everyday Gold + Vision + Adult Dental | HMO | 58594MI0040020 | No |
| Focused Silver | HMO | 58594MI0030019 | No |
| Focused Silver + Vision + Adult Dental | HMO | 58594MI0040019 | No |
| Standard Expanded Bronze | HMO | 58594MI0030023 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 58594MI0040024 | No |
| Standard Gold | HMO | 58594MI0030025 | No |
| Standard Gold + Vision + Adult Dental | HMO | 58594MI0040026 | No |
| Standard Silver | HMO | 58594MI0030024 | No |
| Standard Silver + Vision + Adult Dental | HMO | 58594MI0040025 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Choice Bronze HSA | HMO | 26289NE0020002 | No |
| Choice Bronze HSA + Vision + Adult Dental | HMO | 26289NE0030002 | No |
| Clear Gold | HMO | 26289NE0020050 | No |
| Clear Gold + Vision + Adult Dental | HMO | 26289NE0030044 | No |
| Complete Silver | HMO | 26289NE0020008 | No |
| Complete Silver + Vision + Adult Dental | HMO | 26289NE0030008 | No |
| Elite Bronze | HMO | 26289NE0020007 | No |
| Elite Bronze + Vision + Adult Dental | HMO | 26289NE0030007 | No |
| Elite Gold | HMO | 26289NE0020036 | No |
| Elite Gold + Vision + Adult Dental | HMO | 26289NE0030036 | No |
| Focused Silver | HMO | 26289NE0020048 | No |
| Focused Silver + Vision + Adult Dental | HMO | 26289NE0030042 | No |
| Standard Expanded Bronze | HMO | 26289NE0020039 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 26289NE0030015 | No |
| Standard Gold | HMO | 26289NE0020041 | No |
| Standard Gold + Vision + Adult Dental | HMO | 26289NE0030017 | No |
| Standard Silver | HMO | 26289NE0020040 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Choice Bronze HSA | EPO | 75841NH0090006 | No |
| Choice Bronze HSA + Vision + Adult Dental | EPO | 75841NH0100002 | No |
| Clear Silver | EPO | 75841NH0090013 | No |
| Clear Silver + Vision + Adult Dental | EPO | 75841NH0100010 | No |
| Complete Gold | EPO | 75841NH0090005 | No |
| Complete Gold + Vision + Adult Dental | EPO | 75841NH0100009 | No |
| Complete Silver | EPO | 75841NH0090011 | No |
| Complete Silver + Vision + Adult Dental | EPO | 75841NH0100011 | No |
| Elite Bronze | EPO | 75841NH0090021 | No |
| Elite Bronze + Vision + Adult Dental | EPO | 75841NH0100021 | No |
| Everyday Gold | EPO | 75841NH0090026 | No |
| Everyday Gold + Vision + Adult Dental | EPO | 75841NH0100026 | No |
| Standard Expanded Bronze | EPO | 75841NH0090028 | No |
| Standard Expanded Bronze + Vision + Adult Dental | EPO | 75841NH0100029 | No |
| Standard Gold | EPO | 75841NH0090030 | No |
| Standard Gold + Vision + Adult Dental | EPO | 75841NH0100031 | No |
| Standard Silver | EPO | 75841NH0090029 | No |
| Standard Silver + Vision + Adult Dental | EPO | 75841NH0100030 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Clear Silver | EPO | 34368KS0110049 | No |
| Elite Bronze | EPO | 34368KS0110047 | No |
| Elite Bronze + Vision + Adult Dental | EPO | 34368KS0120047 | No |
| Elite Gold | EPO | 34368KS0110066 | No |
| Elite Gold + Vision + Adult Dental | EPO | 34368KS0120068 | No |
| Everyday Bronze | EPO | 34368KS0110043 | No |
| Everyday Bronze + Vision + Adult Dental | EPO | 34368KS0120043 | No |
| Everyday Gold | EPO | 34368KS0110033 | No |
| Everyday Gold + Vision + Adult Dental | EPO | 34368KS0120033 | No |
| Focused Silver | EPO | 34368KS0110053 | No |
| Focused Silver + Vision + Adult Dental | EPO | 34368KS0120053 | No |
| Standard Expanded Bronze | EPO | 34368KS0110068 | No |
| Standard Expanded Bronze + Vision + Adult Dental | EPO | 34368KS0120069 | No |
| Standard Gold | EPO | 34368KS0110070 | No |
| Standard Gold + Vision + Adult Dental | EPO | 34368KS0120071 | No |
| Standard Silver | EPO | 34368KS0110069 | No |
| Standard Silver + Vision + Adult Dental | EPO | 34368KS0120070 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Clear VALUE Silver | HMO | 87226TX0060007 | No |
| Clear VALUE Silver | HMO | 87226TX0070007 | No |
| Clear VALUE Silver | HMO | 87226TX0080007 | No |
| Clear VALUE Silver | HMO | 87226TX0100007 | No |
| Complete Gold | EPO | 29418TX0140064 | No |
| Complete Gold + Vision + Adult Dental | EPO | 29418TX0160020 | No |
| Complete Silver | EPO | 29418TX0140019 | No |
| Complete Silver + Vision + Adult Dental | EPO | 29418TX0160038 | No |
| Complete VALUE Gold | HMO | 87226TX0060013 | No |
| Complete VALUE Gold | HMO | 87226TX0070013 | No |
| Complete VALUE Gold | HMO | 87226TX0080013 | No |
| Complete VALUE Gold | HMO | 87226TX0100013 | No |
| Everyday Gold | EPO | 29418TX0140102 | No |
| Everyday Gold + Vision + Adult Dental | EPO | 29418TX0160102 | No |
| Focused Silver | EPO | 29418TX0140100 | No |
| Focused Silver + Vision + Adult Dental | EPO | 29418TX0160100 | No |
| Focused VALUE Silver | HMO | 87226TX0060009 | No |
| Focused VALUE Silver | HMO | 87226TX0070009 | No |
| Focused VALUE Silver | HMO | 87226TX0080009 | No |
| Focused VALUE Silver | HMO | 87226TX0100009 | No |
| Focused VALUE Silver + Vision + Adult Dental | HMO | 87226TX0120001 | No |
| Focused VALUE Silver + Vision + Adult Dental | HMO | 87226TX0130003 | No |
| Focused VALUE Silver + Vision + Adult Dental | HMO | 87226TX0140003 | No |
| Focused VALUE Silver + Vision + Adult Dental | HMO | 87226TX0150001 | No |
| Standard Gold | EPO | 29418TX0140109 | No |
| Standard Gold + Vision + Adult Dental | EPO | 29418TX0160052 | No |
| Standard Gold VALUE | HMO | 87226TX0060012 | No |
| Standard Gold VALUE | HMO | 87226TX0070012 | No |
| Standard Gold VALUE | HMO | 87226TX0080012 | No |
| Standard Gold VALUE | HMO | 87226TX0100012 | No |
| Standard Silver | EPO | 29418TX0140108 | No |
| Standard Silver VALUE | HMO | 87226TX0060011 | No |
| Standard Silver VALUE | HMO | 87226TX0070011 | No |
| Standard Silver VALUE | HMO | 87226TX0080011 | No |
| Standard Silver VALUE | HMO | 87226TX0100011 | No |
| Standard Silver VALUE + Vision + Adult Dental | HMO | 87226TX0120005 | No |
| Standard Silver VALUE + Vision + Adult Dental | HMO | 87226TX0130002 | No |
| Standard Silver VALUE + Vision + Adult Dental | HMO | 87226TX0140004 | No |
| Standard Silver VALUE + Vision + Adult Dental | HMO | 87226TX0150003 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Choice Bronze HSA | HMO | 35065IN0040002 | No |
| Choice Bronze HSA | HMO | 41047OH0010045 | No |
| Choice Bronze HSA + Vision + Adult Dental | HMO | 35065IN0050002 | No |
| Choice Bronze HSA + Vision + Adult Dental | HMO | 41047OH0030045 | No |
| Clear Gold | HMO | 41047OH0010067 | No |
| Clear Gold + Vision + Adult Dental | HMO | 41047OH0030071 | No |
| Clear Silver | HMO | 35065IN0040003 | No |
| Clear Silver | HMO | 41047OH0010061 | No |
| Complete Gold | HMO | 35065IN0040004 | No |
| Complete Gold | HMO | 41047OH0010041 | No |
| Complete Gold | HMO | 48286IA0010015 | No |
| Complete Gold | HMO | 49004FL0010011 | No |
| Complete Gold | HMO | 49004FL0010025 | No |
| Complete Gold + Vision + Adult Dental | HMO | 35065IN0050003 | No |
| Complete Gold + Vision + Adult Dental | HMO | 41047OH0030041 | No |
| Complete Gold + Vision + Adult Dental | HMO | 48286IA0020015 | No |
| Complete Gold + Vision + Adult Dental | HMO | 49004FL0020010 | No |
| Complete Gold + Vision + Adult Dental | HMO | 49004FL0020021 | No |
| Complete Silver | HMO | 41047OH0010025 | No |
| Complete Silver + Vision + Adult Dental | HMO | 41047OH0030025 | No |
| Complete VALUE Gold | HMO | 86382FL0050010 | No |
| Complete VALUE Silver | HMO | 86382FL0050006 | No |
| Elite Bronze | HMO | 48286IA0010013 | No |
| Elite Bronze | HMO | 49004FL0010004 | No |
| Elite Bronze | HMO | 49004FL0010017 | No |
| Elite Bronze + Vision + Adult Dental | HMO | 48286IA0020013 | No |
| Elite Bronze + Vision + Adult Dental | HMO | 49004FL0020004 | No |
| Elite Bronze + Vision + Adult Dental | HMO | 49004FL0020015 | No |
| Elite Gold | HMO | 35065IN0040007 | No |
| Elite Gold + Vision + Adult Dental | HMO | 35065IN0050006 | No |
| Elite Silver | HMO | 48286IA0010022 | No |
| Elite Silver | HMO | 49004FL0010008 | No |
| Elite Silver | HMO | 49004FL0010020 | No |
| Elite Silver + Vision + Adult Dental | HMO | 48286IA0020021 | No |
| Elite Silver + Vision + Adult Dental | HMO | 49004FL0020007 | No |
| Elite Silver + Vision + Adult Dental | HMO | 49004FL0020017 | No |
| Elite VALUE Bronze | HMO | 86382FL0050005 | No |
| Enhanced Diabetes Care Silver with $0 Drug Options | HMO | 49004FL0010009 | No |
| Enhanced Diabetes Care Silver with $0 Drug Options | HMO | 49004FL0010023 | No |
| Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental | HMO | 49004FL0020008 | No |
| Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental | HMO | 49004FL0020020 | No |
| Everyday Bronze | HMO | 35065IN0040008 | No |
| Everyday Bronze | HMO | 41047OH0010057 | No |
| Everyday Bronze | HMO | 48286IA0010012 | No |
| Everyday Bronze | HMO | 49004FL0010002 | No |
| Everyday Bronze | HMO | 49004FL0010015 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 35065IN0050007 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 41047OH0030057 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 48286IA0020012 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 49004FL0020002 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 49004FL0020013 | No |
| Everyday Gold | HMO | 48286IA0010016 | No |
| Everyday Gold | HMO | 49004FL0010010 | No |
| Everyday Gold | HMO | 49004FL0010026 | No |
| Everyday Gold + Vision + Adult Dental | HMO | 48286IA0020016 | No |
| Everyday Gold + Vision + Adult Dental | HMO | 49004FL0020009 | No |
| Everyday Gold + Vision + Adult Dental | HMO | 49004FL0020022 | No |
| Focused Silver | HMO | 35065IN0040010 | No |
| Focused Silver | HMO | 48286IA0010019 | No |
| Focused Silver | HMO | 49004FL0010007 | No |
| Focused Silver | HMO | 49004FL0010021 | No |
| Focused Silver + Vision + Adult Dental | HMO | 35065IN0050009 | No |
| Focused Silver + Vision + Adult Dental | HMO | 48286IA0020019 | No |
| Focused Silver + Vision + Adult Dental | HMO | 49004FL0020006 | No |
| Focused Silver + Vision + Adult Dental | HMO | 49004FL0020018 | No |
| Focused VALUE Silver | HMO | 86382FL0050009 | No |
| Standard Expanded Bronze | HMO | 35065IN0040012 | No |
| Standard Expanded Bronze | HMO | 41047OH0010069 | No |
| Standard Expanded Bronze | HMO | 48286IA0010014 | No |
| Standard Expanded Bronze | HMO | 49004FL0010001 | No |
| Standard Expanded Bronze | HMO | 49004FL0010018 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 35065IN0050011 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 41047OH0030072 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 48286IA0020014 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 49004FL0020001 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 49004FL0020016 | No |
| Standard Expanded Bronze VALUE | HMO | 86382FL0050017 | No |
| Standard Gold | HMO | 35065IN0040013 | No |
| Standard Gold | HMO | 41047OH0010071 | No |
| Standard Gold | HMO | 48286IA0010017 | No |
| Standard Gold | HMO | 49004FL0010013 | No |
| Standard Gold | HMO | 49004FL0010028 | No |
| Standard Gold + Vision + Adult Dental | HMO | 35065IN0050012 | No |
| Standard Gold + Vision + Adult Dental | HMO | 41047OH0030074 | No |
| Standard Gold + Vision + Adult Dental | HMO | 48286IA0020017 | No |
| Standard Gold + Vision + Adult Dental | HMO | 49004FL0020012 | No |
| Standard Gold + Vision + Adult Dental | HMO | 49004FL0020024 | No |
| Standard Gold VALUE | HMO | 86382FL0050019 | No |
| Standard Silver | HMO | 35065IN0040001 | No |
| Standard Silver | HMO | 41047OH0010070 | No |
| Standard Silver | HMO | 48286IA0010020 | No |
| Standard Silver | HMO | 49004FL0010006 | No |
| Standard Silver | HMO | 49004FL0010024 | No |
| Standard Silver + Vision + Adult Dental | HMO | 35065IN0050001 | No |
| Standard Silver + Vision + Adult Dental | HMO | 41047OH0030073 | No |
| Standard Silver VALUE | HMO | 86382FL0050018 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Clear Gold | EPO | 64004DE0090011 | No |
| Clear Gold + Vision + Adult Dental | EPO | 64004DE0100011 | No |
| Complete Gold | EPO | 64004DE0090009 | No |
| Complete Gold + Vision + Adult Dental | EPO | 64004DE0100009 | No |
| Elite Silver | EPO | 64004DE0090013 | No |
| Elite Silver + Vision + Adult Dental | EPO | 64004DE0100013 | No |
| Everyday Bronze | EPO | 64004DE0090002 | No |
| Everyday Bronze + Vision + Adult Dental | EPO | 64004DE0100002 | No |
| Focused Silver | EPO | 64004DE0090007 | No |
| Focused Silver + Vision + Adult Dental | EPO | 64004DE0100007 | No |
| Premier Bronze HSA | EPO | 64004DE0090001 | No |
| Premier Bronze HSA + Vision + Adult Dental | EPO | 64004DE0100001 | No |
| Standard Expanded Bronze | EPO | 64004DE0090004 | No |
| Standard Expanded Bronze + Vision + Adult Dental | EPO | 64004DE0100004 | No |
| Standard Gold | EPO | 64004DE0090012 | No |
| Standard Gold + Vision + Adult Dental | EPO | 64004DE0100012 | No |
| Standard Silver | EPO | 64004DE0090008 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Complete Gold | EPO | 53932AL0100015 | No |
| Complete Gold + Vision + Adult Dental | EPO | 53932AL0110010 | No |
| Elite Bronze | EPO | 53932AL0100014 | No |
| Elite Bronze + Vision + Adult Dental | EPO | 53932AL0110014 | No |
| Elite Gold | EPO | 53932AL0100016 | No |
| Elite Gold + Vision + Adult Dental | EPO | 53932AL0110015 | No |
| Elite Silver | EPO | 53932AL0100017 | No |
| Elite Silver + Vision + Adult Dental | EPO | 53932AL0110016 | No |
| Everyday Bronze | EPO | 53932AL0100003 | No |
| Everyday Bronze + Vision + Adult Dental | EPO | 53932AL0110003 | No |
| Focused Silver | EPO | 53932AL0100005 | No |
| Focused Silver + Vision + Adult Dental | EPO | 53932AL0110005 | No |
| Standard Expanded Bronze | EPO | 53932AL0100011 | No |
| Standard Expanded Bronze + Vision + Adult Dental | EPO | 53932AL0110011 | No |
| Standard Gold | EPO | 53932AL0100013 | No |
| Standard Gold + Vision + Adult Dental | EPO | 53932AL0110013 | No |
| Standard Silver | EPO | 53932AL0100012 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Central Bronze | HMO | 27833IL0140069 | No |
| Central Bronze + Vision + Adult Dental | HMO | 27833IL0150069 | No |
| Central Gold | HMO | 27833IL0140071 | No |
| Central Gold + Vision + Adult Dental | HMO | 27833IL0150071 | No |
| Clear Silver | HMO | 27833IL0140061 | No |
| Everyday Bronze | HMO | 27833IL0140016 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 27833IL0150016 | No |
| Everyday Gold | HMO | 27833IL0140064 | No |
| Everyday Gold + Vision + Adult Dental | HMO | 27833IL0150059 | No |
| Focused Silver | HMO | 27833IL0140063 | No |
| Focused Silver + Vision + Adult Dental | HMO | 27833IL0150058 | No |
| Standard Expanded Bronze | HMO | 27833IL0140073 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 27833IL0150072 | No |
| Standard Gold | HMO | 27833IL0140075 | No |
| Standard Gold + Vision + Adult Dental | HMO | 27833IL0150074 | No |
| Standard Silver | HMO | 27833IL0140074 | No |
| Standard Silver + Vision + Adult Dental | HMO | 27833IL0150073 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Clear Silver with $0 Insulin Options | HMO | 77264NC0010037 | No |
| Complete Gold | HMO | 77264NC0010007 | No |
| Complete Gold + Vision + Adult Dental | HMO | 77264NC0020007 | No |
| Complete Gold with Atrium Health | HMO | 77264NC0010056 | No |
| Complete Gold with Atrium Health + Vision + Adult Dental | HMO | 77264NC0020053 | No |
| Complete Silver with Atrium Health | HMO | 77264NC0010051 | No |
| Complete Silver with Atrium Health + Vision + Adult Dental | HMO | 77264NC0020048 | No |
| Elite Bronze | HMO | 77264NC0010036 | No |
| Elite Bronze + Vision + Adult Dental | HMO | 77264NC0020036 | No |
| Elite Bronze with Atrium Health | HMO | 77264NC0010050 | No |
| Elite Bronze with Atrium Health + Vision + Adult Dental | HMO | 77264NC0020047 | No |
| Everyday Bronze | HMO | 77264NC0010028 | No |
| Everyday Bronze + Vision + Adult Dental | HMO | 77264NC0020028 | No |
| Everyday Bronze with Atrium Health | HMO | 77264NC0010049 | No |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | HMO | 77264NC0020046 | No |
| Focused Silver | HMO | 77264NC0010039 | No |
| Focused Silver + Vision + Adult Dental | HMO | 77264NC0020039 | No |
| Focused Silver with Atrium Health | HMO | 77264NC0010054 | No |
| Focused Silver with Atrium Health + Vision + Adult Dental | HMO | 77264NC0020051 | No |
| Standard Expanded Bronze | HMO | 77264NC0010044 | No |
| Standard Expanded Bronze + Vision + Adult Dental | HMO | 77264NC0020055 | No |
| Standard Expanded Bronze with Atrium Health | HMO | 77264NC0010059 | No |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | HMO | 77264NC0020058 | No |
| Standard Gold | HMO | 77264NC0010046 | No |
| Standard Gold + Vision + Adult Dental | HMO | 77264NC0020057 | No |
| Standard Gold with Atrium Health | HMO | 77264NC0010061 | No |
| Standard Gold with Atrium Health + Vision + Adult Dental | HMO | 77264NC0020060 | No |
| Standard Silver | HMO | 77264NC0010045 | No |
| Standard Silver + Vision + Adult Dental | HMO | 77264NC0020056 | No |
| Standard Silver with Atrium Health | HMO | 77264NC0010060 | No |
| Standard Silver with Atrium Health + Vision + Adult Dental | HMO | 77264NC0020059 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Elite Bronze | PPO | 62505OK0120006 | No |
| Elite Bronze + Vision + Adult Dental | PPO | 62505OK0130006 | No |
| Elite Gold | PPO | 62505OK0120016 | No |
| Elite Gold + Vision + Adult Dental | PPO | 62505OK0130017 | No |
| Everyday Bronze | PPO | 62505OK0120002 | No |
| Everyday Bronze + Vision + Adult Dental | PPO | 62505OK0130002 | No |
| Everyday Gold | PPO | 62505OK0120014 | No |
| Everyday Gold + Vision + Adult Dental | PPO | 62505OK0130014 | No |
| Focused Silver | PPO | 62505OK0120012 | No |
| Focused Silver + Vision + Adult Dental | PPO | 62505OK0130012 | No |
| Standard Expanded Bronze | PPO | 62505OK0120019 | No |
| Standard Expanded Bronze + Vision + Adult Dental | PPO | 62505OK0130019 | No |
| Standard Gold | PPO | 62505OK0120021 | No |
| Standard Gold + Vision + Adult Dental | PPO | 62505OK0130021 | No |
| Standard Silver | PPO | 62505OK0120020 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Clear Silver | EPO | 70111TN0110027 | No |
| Elite Bronze | EPO | 70111TN0110026 | No |
| Elite Bronze + Vision + Adult Dental | EPO | 70111TN0120026 | No |
| Elite Gold | EPO | 70111TN0110031 | No |
| Elite Gold + Vision + Adult Dental | EPO | 70111TN0120034 | No |
| Enhanced Diabetes Care Silver with $0 Drug Options | EPO | 70111TN0110018 | No |
| Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental | EPO | 70111TN0120001 | No |
| Everyday Bronze | EPO | 70111TN0110023 | No |
| Everyday Bronze + Vision + Adult Dental | EPO | 70111TN0120023 | No |
| Everyday Gold | EPO | 70111TN0110030 | No |
| Everyday Gold + Vision + Adult Dental | EPO | 70111TN0120030 | No |
| Focused Silver | EPO | 70111TN0110029 | No |
| Focused Silver + Vision + Adult Dental | EPO | 70111TN0120029 | No |
| Standard Expanded Bronze | EPO | 70111TN0110033 | No |
| Standard Expanded Bronze + Vision + Adult Dental | EPO | 70111TN0120035 | No |
| Standard Gold | EPO | 70111TN0110035 | No |
| Standard Gold + Vision + Adult Dental | EPO | 70111TN0120037 | No |
| Standard Silver | EPO | 70111TN0110034 | No |
| Standard Silver + Vision + Adult Dental | EPO | 70111TN0120036 | 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? |
|---|---|---|---|
| Bronze Exp Standardized | PPO | 75293AR1200029 | No |
| Bronze Value | PPO | 75293AR1200024 | No |
| Gold Standardized | PPO | 75293AR1200025 | No |
| Silver AH | PPO | 75293AR1200004 | No |
| Silver Standardized | PPO | 75293AR1200026 | No |
| Silver Value | PPO | 75293AR1200023 | No |
| Dental Gold | PPO | 75293AR1230003 | Yes |
| Dental Gold Plus Vision | PPO | 75293AR1230004 | Yes |
| Dental Pediatric | PPO | 75293AR1230001 | Yes |
| Dental Platinum | PPO | 75293AR1230005 | Yes |
| Dental Platinum Plus Vision | PPO | 75293AR1230006 | Yes |
| Dental Platinum Premium | PPO | 75293AR1230007 | Yes |
| Dental Platinum Premium Plus Vision | PPO | 75293AR1230008 | Yes |
| Dental Silver | PPO | 75293AR1230002 | Yes |
| 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? |
|---|---|---|---|
| AvMed Entrust Bronze 600 (2025) | HMO | 19898FL0340006 | No |
| AvMed Entrust Bronze 600 (2025) | HMO | 19898FL0340016 | No |
| AvMed Entrust Bronze 600 (2025) | HMO | 19898FL0340026 | No |
| AvMed Entrust Bronze 600 (2025) | HMO | 19898FL0340036 | No |
| AvMed Entrust Bronze 600 (2025) | HMO | 19898FL0340046 | No |
| AvMed Entrust Bronze 650 (2025) | HMO | 19898FL0340007 | No |
| AvMed Entrust Bronze 650 (2025) | HMO | 19898FL0340017 | No |
| AvMed Entrust Bronze 650 (2025) | HMO | 19898FL0340027 | No |
| AvMed Entrust Bronze 650 (2025) | HMO | 19898FL0340037 | No |
| AvMed Entrust Bronze 650 (2025) | HMO | 19898FL0340047 | No |
| AvMed Entrust Expanded Bronze Standard (2025) | HMO | 19898FL0340091 | No |
| AvMed Entrust Expanded Bronze Standard (2025) | HMO | 19898FL0340092 | No |
| AvMed Entrust Expanded Bronze Standard (2025) | HMO | 19898FL0340093 | No |
| AvMed Entrust Expanded Bronze Standard (2025) | HMO | 19898FL0340094 | No |
| AvMed Entrust Expanded Bronze Standard (2025) | HMO | 19898FL0340095 | No |
| AvMed Entrust Gold 125 (2025) | HMO | 19898FL0340001 | No |
| AvMed Entrust Gold 125 (2025) | HMO | 19898FL0340011 | No |
| AvMed Entrust Gold 125 (2025) | HMO | 19898FL0340021 | No |
| AvMed Entrust Gold 125 (2025) | HMO | 19898FL0340031 | No |
| AvMed Entrust Gold 125 (2025) | HMO | 19898FL0340041 | No |
| AvMed Entrust Gold 125 Dental+Vision (2025) | HMO | 19898FL0350001 | No |
| AvMed Entrust Gold 125 Dental+Vision (2025) | HMO | 19898FL0350011 | No |
| AvMed Entrust Gold 125 Dental+Vision (2025) | HMO | 19898FL0350021 | No |
| AvMed Entrust Gold 125 Dental+Vision (2025) | HMO | 19898FL0350031 | No |
| AvMed Entrust Gold 125 Dental+Vision (2025) | HMO | 19898FL0350041 | No |
| AvMed Entrust Gold Standard (2025) | HMO | 19898FL0340071 | No |
| AvMed Entrust Gold Standard (2025) | HMO | 19898FL0340072 | No |
| AvMed Entrust Gold Standard (2025) | HMO | 19898FL0340073 | No |
| AvMed Entrust Gold Standard (2025) | HMO | 19898FL0340074 | No |
| AvMed Entrust Gold Standard (2025) | HMO | 19898FL0340075 | No |
| AvMed Entrust Platinum 25 (2025) | HMO | 19898FL0340020 | No |
| AvMed Entrust Platinum 25 (2025) | HMO | 19898FL0340061 | No |
| AvMed Entrust Platinum 25 (2025) | HMO | 19898FL0340064 | No |
| AvMed Entrust Platinum 25 Dental+Vision (2025) | HMO | 19898FL0350020 | No |
| AvMed Entrust Platinum 25 Dental+Vision (2025) | HMO | 19898FL0350061 | No |
| AvMed Entrust Platinum 25 Dental+Vision (2025) | HMO | 19898FL0350064 | No |
| AvMed Entrust Platinum Standard (2025) | HMO | 19898FL0340062 | No |
| AvMed Entrust Platinum Standard (2025) | HMO | 19898FL0340063 | No |
| AvMed Entrust Platinum Standard (2025) | HMO | 19898FL0340065 | No |
| AvMed Entrust Silver 350 (2025) | HMO | 19898FL0340003 | No |
| AvMed Entrust Silver 350 (2025) | HMO | 19898FL0340013 | No |
| AvMed Entrust Silver 350 (2025) | HMO | 19898FL0340023 | No |
| AvMed Entrust Silver 350 (2025) | HMO | 19898FL0340033 | No |
| AvMed Entrust Silver 350 (2025) | HMO | 19898FL0340043 | No |
| AvMed Entrust Silver 350 Dental+Vision (2025) | HMO | 19898FL0350003 | No |
| AvMed Entrust Silver 350 Dental+Vision (2025) | HMO | 19898FL0350013 | No |
| AvMed Entrust Silver 350 Dental+Vision (2025) | HMO | 19898FL0350023 | No |
| AvMed Entrust Silver 350 Dental+Vision (2025) | HMO | 19898FL0350033 | No |
| AvMed Entrust Silver 350 Dental+Vision (2025) | HMO | 19898FL0350043 | No |
| AvMed Entrust Silver 550 (2025) | HMO | 19898FL0340005 | No |
| AvMed Entrust Silver 550 (2025) | HMO | 19898FL0340015 | No |
| AvMed Entrust Silver 550 (2025) | HMO | 19898FL0340025 | No |
| AvMed Entrust Silver 550 (2025) | HMO | 19898FL0340035 | No |
| AvMed Entrust Silver 550 (2025) | HMO | 19898FL0340045 | No |
| AvMed Entrust Silver 550 Dental+Vision (2025) | HMO | 19898FL0350005 | No |
| AvMed Entrust Silver 550 Dental+Vision (2025) | HMO | 19898FL0350015 | No |
| AvMed Entrust Silver 550 Dental+Vision (2025) | HMO | 19898FL0350025 | No |
| AvMed Entrust Silver 550 Dental+Vision (2025) | HMO | 19898FL0350035 | No |
| AvMed Entrust Silver 550 Dental+Vision (2025) | HMO | 19898FL0350045 | No |
| AvMed Entrust Silver Standard (2025) | HMO | 19898FL0340081 | No |
| AvMed Entrust Silver Standard (2025) | HMO | 19898FL0340082 | No |
| AvMed Entrust Silver Standard (2025) | HMO | 19898FL0340083 | No |
| AvMed Entrust Silver Standard (2025) | HMO | 19898FL0340084 | No |
| AvMed Entrust Silver Standard (2025) | HMO | 19898FL0340085 | 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 Max 70/50 $6700 | PPO | 97176LA0340017 | No |
| Blue Max 90/70 $1500 | PPO | 97176LA0340015 | No |
| Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 | PPO | 97176LA0340010 | No |
| Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan | PPO | 97176LA0340024 | No |
| Blue Max Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan | PPO | 97176LA0340023 | No |
| Blue Max Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan | PPO | 97176LA0340022 | No |
| Blue Saver 60/40 $6100 | PPO | 97176LA0350004 | No |
| Blue Saver 90/70 $3200 | PPO | 97176LA0350003 | 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 | 33602TX0460554 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460705 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460705 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460706 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460706 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460707 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460707 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460708 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460708 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460709 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460709 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460710 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460710 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460711 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460711 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460712 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460712 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460713 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460713 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460714 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460714 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460715 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460715 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460716 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460716 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460717 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460717 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460718 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460718 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460719 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460719 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460721 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460721 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460722 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460722 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460723 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460723 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460724 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460724 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460725 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460725 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460726 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460726 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460727 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460727 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460728 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460728 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460869 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0460869 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0461073 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0461073 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0461074 | No |
| Blue Advantage Bronze HMO? 204 | HMO | 33602TX0461074 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460782 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460782 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460783 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460783 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460787 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460787 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460792 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460792 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460793 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460793 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460794 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460794 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460795 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460795 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460797 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460797 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460799 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460799 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460801 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460801 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460802 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460802 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460803 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460803 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460804 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460804 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460806 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460806 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460871 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0460871 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0461076 | No |
| Blue Advantage Bronze HMO? 301 | HMO | 33602TX0461076 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461033 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461033 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461034 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461034 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461035 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461035 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461036 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461036 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461037 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461037 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461038 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461038 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461039 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461039 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461040 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461040 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461041 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461041 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461042 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461042 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461043 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461043 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461044 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461044 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461045 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461045 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461046 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461046 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461047 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461047 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461048 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461048 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461049 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461049 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461050 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461050 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461051 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461051 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461052 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461052 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461053 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461053 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461054 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461054 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461055 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461055 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461056 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461056 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461057 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461057 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461058 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461058 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461079 | No |
| Blue Advantage Bronze HMO? Standard | HMO | 33602TX0461079 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460548 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460548 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460555 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460555 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460556 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460556 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460557 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460557 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460558 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460558 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460559 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460559 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460560 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460560 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460561 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460561 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460562 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460562 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460563 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460563 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460564 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460564 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460565 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460565 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460566 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460566 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460567 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460567 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460568 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460568 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460569 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460569 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460571 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460571 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460572 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460572 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460573 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460573 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460574 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460574 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460575 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460575 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460576 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460576 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460577 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460577 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460578 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460578 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460863 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0460863 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0461061 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0461061 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0461062 | No |
| Blue Advantage Gold HMO? 206 | HMO | 33602TX0461062 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460809 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460809 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460814 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460814 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460819 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460819 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460820 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460820 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460821 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460821 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460822 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460822 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460824 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460824 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460826 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460826 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460828 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460828 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460829 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460829 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460830 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460830 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460831 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460831 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460833 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460833 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460860 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460860 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460865 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0460865 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0461066 | No |
| Blue Advantage Gold HMO? 603 | HMO | 33602TX0461066 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460925 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460925 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460928 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460928 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460929 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460929 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460930 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460930 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460931 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460931 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460932 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460932 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460933 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460933 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460934 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460934 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460935 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460935 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460936 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460936 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460937 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460937 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460938 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460938 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460939 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460939 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460940 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460940 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460941 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460941 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460942 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460942 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460943 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460943 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460944 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460944 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460945 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460945 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460946 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460946 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460947 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460947 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460948 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460948 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460949 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460949 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460950 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460950 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460951 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460951 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460952 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460952 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460953 | No |
| Blue Advantage Gold HMO? Standard | HMO | 33602TX0460953 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870002 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870002 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870038 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870038 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870039 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870039 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870040 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870040 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870041 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870041 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870042 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870042 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870043 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870043 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870044 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870044 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870045 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870045 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870046 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870046 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870047 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870047 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870048 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870048 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870049 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870049 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870050 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870050 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870051 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870051 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870052 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870052 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870053 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870053 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870054 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870054 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870055 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870055 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870056 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870056 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870057 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870057 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870058 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870058 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870059 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870059 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870060 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870060 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870061 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870061 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870062 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870062 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870063 | No |
| Blue Advantage Plus Bronze? 303 | POS | 33602TX0870063 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870003 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870003 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870064 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870064 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870065 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870065 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870066 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870066 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870067 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870067 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870068 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870068 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870069 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870069 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870070 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870070 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870071 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870071 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870072 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870072 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870073 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870073 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870074 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870074 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870075 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870075 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870076 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870076 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870077 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870077 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870078 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870078 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870079 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870079 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870080 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870080 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870081 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870081 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870082 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870082 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870083 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870083 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870084 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870084 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870085 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870085 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870086 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870086 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870087 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870087 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870088 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870088 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870089 | No |
| Blue Advantage Plus Bronze? 305 | POS | 33602TX0870089 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870004 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870004 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870090 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870090 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870091 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870091 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870092 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870092 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870093 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870093 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870094 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870094 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870095 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870095 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870096 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870096 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870097 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870097 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870098 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870098 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870099 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870099 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870100 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870100 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870101 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870101 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870102 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870102 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870103 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870103 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870104 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870104 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870105 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870105 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870106 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870106 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870107 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870107 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870108 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870108 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870109 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870109 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870110 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870110 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870111 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870111 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870112 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870112 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870113 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870113 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870114 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870114 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870115 | No |
| Blue Advantage Plus Bronze? Standard | POS | 33602TX0870115 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870005 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870005 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870116 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870116 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870117 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870117 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870118 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870118 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870119 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870119 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870120 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870120 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870121 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870121 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870122 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870122 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870123 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870123 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870124 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870124 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870125 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870125 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870126 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870126 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870127 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870127 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870128 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870128 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870129 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870129 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870130 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870130 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870131 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870131 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870132 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870132 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870133 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870133 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870134 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870134 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870135 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870135 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870136 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870136 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870137 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870137 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870138 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870138 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870139 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870139 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870140 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870140 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870141 | No |
| Blue Advantage Plus Gold? 203 | POS | 33602TX0870141 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870011 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870011 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870272 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870272 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870273 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870273 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870274 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870274 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870275 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870275 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870276 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870276 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870277 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870277 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870278 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870278 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870279 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870279 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870280 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870280 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870281 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870281 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870282 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870282 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870283 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870283 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870284 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870284 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870285 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870285 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870286 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870286 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870287 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870287 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870288 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870288 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870289 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870289 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870290 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870290 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870291 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870291 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870292 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870292 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870293 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870293 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870294 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870294 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870295 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870295 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870296 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870296 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870297 | No |
| Blue Advantage Plus Gold? 803 | POS | 33602TX0870297 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870006 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870006 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870142 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870142 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870143 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870143 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870144 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870144 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870145 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870145 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870146 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870146 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870147 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870147 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870148 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870148 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870149 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870149 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870150 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870150 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870151 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870151 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870152 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870152 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870153 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870153 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870154 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870154 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870155 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870155 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870156 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870156 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870157 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870157 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870158 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870158 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870159 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870159 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870160 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870160 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870161 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870161 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870162 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870162 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870163 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870163 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870164 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870164 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870165 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870165 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870166 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870166 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870167 | No |
| Blue Advantage Plus Gold? Standard | POS | 33602TX0870167 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870007 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870007 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870168 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870168 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870169 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870169 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870170 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870170 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870171 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870171 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870172 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870172 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870173 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870173 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870174 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870174 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870175 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870175 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870176 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870176 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870177 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870177 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870178 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870178 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870179 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870179 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870180 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870180 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870181 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870181 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870182 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870182 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870183 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870183 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870184 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870184 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870185 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870185 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870186 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870186 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870187 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870187 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870188 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870188 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870189 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870189 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870190 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870190 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870191 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870191 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870192 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870192 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870193 | No |
| Blue Advantage Plus Silver? 202 | POS | 33602TX0870193 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870009 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870009 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870220 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870220 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870221 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870221 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870222 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870222 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870223 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870223 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870224 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870224 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870225 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870225 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870226 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870226 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870227 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870227 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870228 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870228 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870229 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870229 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870230 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870230 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870231 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870231 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870232 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870232 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870233 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870233 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870234 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870234 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870235 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870235 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870236 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870236 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870237 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870237 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870238 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870238 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870239 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870239 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870240 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870240 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870241 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870241 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870242 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870242 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870243 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870243 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870244 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870244 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870245 | No |
| Blue Advantage Plus Silver? 605 | POS | 33602TX0870245 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870010 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870010 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870246 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870246 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870247 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870247 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870248 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870248 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870249 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870249 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870250 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870250 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870251 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870251 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870252 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870252 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870253 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870253 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870254 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870254 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870255 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870255 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870256 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870256 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870257 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870257 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870258 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870258 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870259 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870259 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870260 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870260 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870261 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870261 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870262 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870262 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870263 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870263 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870264 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870264 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870265 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870265 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870266 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870266 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870267 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870267 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870268 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870268 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870269 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870269 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870270 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870270 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870271 | No |
| Blue Advantage Plus Silver? Standard | POS | 33602TX0870271 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460552 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460552 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460655 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460655 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460656 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460656 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460657 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460657 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460658 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460658 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460659 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460659 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460660 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460660 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460661 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460661 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460662 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460662 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460663 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460663 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460664 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460664 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460665 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460665 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460666 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460666 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460667 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460667 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460668 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460668 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460669 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460669 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460671 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460671 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460672 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460672 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460673 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460673 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460674 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460674 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460675 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460675 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460676 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460676 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460677 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460677 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460678 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460678 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460872 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0460872 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0461077 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0461077 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0461078 | No |
| Blue Advantage Security HMO? 200 | HMO | 33602TX0461078 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460553 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460553 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460680 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460680 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460681 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460681 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460682 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460682 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460683 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460683 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460684 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460684 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460685 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460685 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460686 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460686 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460687 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460687 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460688 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460688 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460689 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460689 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460690 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460690 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460691 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460691 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460692 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460692 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460693 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460693 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460694 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460694 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460696 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460696 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460697 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460697 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460698 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460698 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460699 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460699 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460700 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460700 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460701 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460701 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460702 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460702 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460703 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460703 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460867 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0460867 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0461069 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0461069 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0461070 | No |
| Blue Advantage Silver HMO? 205 | HMO | 33602TX0461070 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461083 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461083 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461090 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461090 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461094 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461094 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461099 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461099 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461100 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461100 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461101 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461101 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461102 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461102 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461104 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461104 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461105 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461105 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461107 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461107 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461108 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461108 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461109 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461109 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461110 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461110 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461112 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461112 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461114 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461114 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461115 | No |
| Blue Advantage Silver HMO? 801 | HMO | 33602TX0461115 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460926 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460926 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460954 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460954 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460955 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460955 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460956 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460956 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460957 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460957 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460958 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460958 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460959 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460959 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460960 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460960 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460961 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460961 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460962 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460962 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460963 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460963 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460964 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460964 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460965 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460965 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460966 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460966 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460967 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460967 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460968 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460968 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460969 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460969 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460970 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460970 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460971 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460971 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460972 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460972 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460973 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460973 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460974 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460974 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460975 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460975 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460976 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460976 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460977 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460977 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460978 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460978 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460979 | No |
| Blue Advantage Silver HMO? Standard | HMO | 33602TX0460979 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461080 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461080 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461116 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461116 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461117 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461117 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461118 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461118 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461119 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461119 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461120 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461120 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461121 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461121 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461122 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461122 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461179 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461179 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461196 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461196 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461197 | No |
| MyBlue Health Bronze? 402 | HMO | 33602TX0461197 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461087 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461087 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461159 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461159 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461160 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461160 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461161 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461161 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461163 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461163 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461164 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461164 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461185 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461185 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461198 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461198 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461199 | No |
| MyBlue Health Bronze? Standard | HMO | 33602TX0461199 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461081 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461081 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461123 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461123 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461124 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461124 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461125 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461125 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461126 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461126 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461127 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461127 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461128 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461128 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461129 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461129 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461180 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461180 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461200 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461200 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461201 | No |
| MyBlue Health Gold? 403 | HMO | 33602TX0461201 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461088 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461088 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461166 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461166 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461167 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461167 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461168 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461168 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461170 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461170 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461171 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461171 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461186 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461186 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461202 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461202 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461203 | No |
| MyBlue Health Gold? Standard | HMO | 33602TX0461203 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461082 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461082 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461130 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461130 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461131 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461131 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461132 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461132 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461133 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461133 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461134 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461134 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461135 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461135 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461136 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461136 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461181 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461181 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461204 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461204 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461205 | No |
| MyBlue Health Silver? 405 | HMO | 33602TX0461205 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461089 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461089 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461173 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461173 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461174 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461174 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461175 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461175 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461177 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461177 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461178 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461178 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461187 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461187 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461208 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461208 | No |
| MyBlue Health Silver? Standard | HMO | 33602TX0461209 | 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? |
|---|---|---|---|
| Chorus Bronze Complete | EPO | 14630WI0010010 | No |
| Chorus Bronze HDHP | EPO | 14630WI0010005 | No |
| Chorus Catastrophic | EPO | 14630WI0010008 | No |
| Chorus Core Bronze | EPO | 14630WI0010015 | No |
| Chorus Core Gold | EPO | 14630WI0010014 | No |
| Chorus Core Silver | EPO | 14630WI0010013 | No |
| Chorus Gold | EPO | 14630WI0010004 | No |
| Chorus Silver | EPO | 14630WI0010003 | No |
| Chorus Silver Select | EPO | 14630WI0010007 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| CHRISTUS Bronze | HMO | 98780LA0150001 | No |
| CHRISTUS Bronze | HMO | 98780LA0150002 | No |
| CHRISTUS Bronze | HMO | 98780LA0150003 | No |
| CHRISTUS Bronze Essential | HMO | 98780LA0040001 | No |
| CHRISTUS Bronze Essential | HMO | 98780LA0040002 | No |
| CHRISTUS Bronze Essential | HMO | 98780LA0040003 | No |
| CHRISTUS Bronze Essential Plus | HMO | 98780LA0160001 | No |
| CHRISTUS Bronze Essential Plus | HMO | 98780LA0160002 | No |
| CHRISTUS Bronze Essential Plus | HMO | 98780LA0160003 | No |
| CHRISTUS Bronze Plus | HMO | 98780LA0170001 | No |
| CHRISTUS Bronze Plus | HMO | 98780LA0170002 | No |
| CHRISTUS Bronze Plus | HMO | 98780LA0170003 | No |
| CHRISTUS Gold | HMO | 98780LA0200001 | No |
| CHRISTUS Gold | HMO | 98780LA0200002 | No |
| CHRISTUS Gold | HMO | 98780LA0200003 | No |
| CHRISTUS Gold Essential | HMO | 98780LA0030001 | No |
| CHRISTUS Gold Essential | HMO | 98780LA0030002 | No |
| CHRISTUS Gold Essential | HMO | 98780LA0030003 | No |
| CHRISTUS Gold Essential Plus | HMO | 98780LA0090001 | No |
| CHRISTUS Gold Essential Plus | HMO | 98780LA0090002 | No |
| CHRISTUS Gold Essential Plus | HMO | 98780LA0090003 | No |
| CHRISTUS Gold Plus | HMO | 98780LA0210001 | No |
| CHRISTUS Gold Plus | HMO | 98780LA0210002 | No |
| CHRISTUS Gold Plus | HMO | 98780LA0210003 | No |
| CHRISTUS Silver | HMO | 98780LA0010001 | No |
| CHRISTUS Silver | HMO | 98780LA0010002 | No |
| CHRISTUS Silver | HMO | 98780LA0010003 | No |
| CHRISTUS Silver Essential | HMO | 98780LA0080001 | No |
| CHRISTUS Silver Essential | HMO | 98780LA0080002 | No |
| CHRISTUS Silver Essential | HMO | 98780LA0080003 | No |
| CHRISTUS Silver Essential Plus | HMO | 98780LA0180001 | No |
| CHRISTUS Silver Essential Plus | HMO | 98780LA0180002 | No |
| CHRISTUS Silver Essential Plus | HMO | 98780LA0180003 | No |
| CHRISTUS Silver Plus | HMO | 98780LA0190001 | No |
| CHRISTUS Silver Plus | HMO | 98780LA0190002 | No |
| CHRISTUS Silver Plus | HMO | 98780LA0190003 | No |
| CHRISTUS Standard Expanded Bronze | HMO | 98780LA0140001 | No |
| CHRISTUS Standard Expanded Bronze | HMO | 98780LA0140002 | No |
| CHRISTUS Standard Expanded Bronze | HMO | 98780LA0140003 | No |
| CHRISTUS Standard Gold | HMO | 98780LA0130001 | No |
| CHRISTUS Standard Gold | HMO | 98780LA0130002 | No |
| CHRISTUS Standard Gold | HMO | 98780LA0130003 | No |
| CHRISTUS Standard Silver | HMO | 98780LA0120001 | No |
| CHRISTUS Standard Silver | HMO | 98780LA0120002 | No |
| CHRISTUS Standard Silver | HMO | 98780LA0120003 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Connect Bronze 5500 Indiv Med Deductible | HMO | 76589TX0010044 | No |
| Connect Bronze 6000 Indiv Med Deductible | HMO | 76589TX0010015 | No |
| Connect Bronze 6500 Indiv Med Deductible Enhanced Diabetes Care | HMO | 76589TX0010047 | No |
| Connect Bronze 8500 Indiv Med Deductible | HMO | 76589TX0010018 | No |
| Connect Bronze 8500 Indiv Med Deductible | HMO | 76589TX0010045 | No |
| Connect Bronze CMS Standard | HMO | 76589TX0010029 | No |
| Connect Bronze CMS Standard | HMO | 76589TX0010048 | No |
| Connect Bronze DFW 6500 Indiv Med Deductible Enhanced Diabetes Care | HMO | 76589TX0010016 | No |
| Connect Gold 1000 Indiv Med Deductible | HMO | 76589TX0010035 | No |
| Connect Gold 1000 Indiv Med Deductible | HMO | 76589TX0010050 | No |
| Connect Gold 2500 Indiv Med Deductible Enhanced Diabetes Care | HMO | 76589TX0010026 | No |
| Connect Gold 2500 Indiv Med Deductible Enhanced Diabetes Care | HMO | 76589TX0010036 | No |
| Connect Gold 3250 Indiv Med Deductible | HMO | 76589TX0010025 | No |
| Connect Gold 3500 Indiv Med Deductible | HMO | 76589TX0010037 | No |
| Connect Gold CMS Standard | HMO | 76589TX0010031 | No |
| Connect Gold CMS Standard | HMO | 76589TX0010038 | No |
| Connect Silver 3000 Indiv Med Deductible | HMO | 76589TX0010024 | No |
| Connect Silver 3000 Indiv Med Deductible | HMO | 76589TX0010040 | No |
| Connect Silver 4000 Indiv Med Deductible | HMO | 76589TX0010021 | No |
| Connect Silver 4000 Indiv Med Deductible | HMO | 76589TX0010041 | No |
| Connect Silver CMS Standard | HMO | 76589TX0010030 | No |
| Connect Silver CMS Standard | HMO | 76589TX0010043 | 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? |
|---|---|---|---|
| HA Bronze Exp Standardized | POS | 13262AR0230007 | No |
| HA Bronze Suitcase | POS | 13262AR0230006 | No |
| HA Gold Standardized | POS | 13262AR0230004 | No |
| HA Silver AH | POS | 13262AR0230002 | No |
| HA Silver Premier Suitcase | POS | 13262AR0230008 | No |
| HA Silver Standardized | POS | 13262AR0230005 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Atlas $1,000 Gold | PPO | 20173WI0130020 | No |
| Atlas $1,500 Standard Gold | PPO | 20173WI0130040 | No |
| Atlas $2,650 Plus Silver | PPO | 20173WI0130021 | No |
| Atlas $3,500 HSA Silver | PPO | 20173WI0130026 | No |
| Atlas $5,000 Standard Silver | PPO | 20173WI0130041 | No |
| Atlas $6,500 Plus Bronze | PPO | 20173WI0130023 | No |
| Atlas $7,500 Standard Bronze | PPO | 20173WI0130042 | No |
| Atlas $8,200 HSA Bronze | PPO | 20173WI0130027 | No |
| Atlas $9,200 Catastrophic | PPO | 20173WI0130025 | No |
| Robin Oak $1,000 Gold | PPO | 20173WI0130001 | No |
| Robin Oak $1,500 Standard Gold | PPO | 20173WI0130011 | No |
| Robin Select $2,800 Plus Silver | PPO | 20173WI0130033 | No |
| Robin Select $3,500 HSA Silver | PPO | 20173WI0130037 | No |
| Robin Select $5,000 Standard Silver | PPO | 20173WI0130034 | No |
| Robin Select $6,500 Plus Bronze | PPO | 20173WI0130035 | No |
| Robin Select $7,500 Standard Bronze | PPO | 20173WI0130036 | No |
| Robin Select $8,200 HSA Bronze | PPO | 20173WI0130038 | No |
| Robin Select $9,200 Catastrophic | PPO | 20173WI0130039 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| my Blue Access Major Events PPO Catastrophic 9200 - 3 Free PCP Visits | PPO | 76168DE0690013 | No |
| my Blue Access PPO Bronze 3800 | PPO | 76168DE0690001 | No |
| my Blue Access PPO Bronze 3800 + Adult Dental and Vision | PPO | 76168DE0700001 | No |
| my Blue Access PPO Bronze 7400 HSA - Custom Drug Benefit | PPO | 76168DE0710001 | No |
| my Blue Access PPO Bronze 8900 | PPO | 76168DE0690008 | No |
| my Blue Access PPO Gold 0 | PPO | 76168DE0690004 | No |
| my Blue Access PPO Gold 0 + Adult Dental and Vision | PPO | 76168DE0700004 | No |
| my Blue Access PPO Gold 1700 HSA | PPO | 76168DE0710003 | No |
| my Blue Access PPO Premier Gold 0 | PPO | 76168DE0730001 | No |
| my Blue Access PPO Premier Gold 0 + Adult Dental and Vision | PPO | 76168DE0740002 | No |
| my Blue Access PPO Premier Platinum 0 | PPO | 76168DE0730003 | No |
| my Blue Access PPO Premier Platinum 0 + Adult Dental and Vision | PPO | 76168DE0740004 | No |
| my Blue Access PPO Silver 7000 | PPO | 76168DE0690007 | No |
| my Blue Access PPO Standard Bronze 7500 | PPO | 76168DE0690012 | No |
| my Blue Access PPO Standard Gold 1500 | PPO | 76168DE0690010 | No |
| my Blue Access PPO Standard Platinum 0 | PPO | 76168DE0690011 | No |
| my Blue Access PPO Standard Silver 5000 | PPO | 76168DE0690009 | No |
| my Blue Access PPO Standard Silver 5000 + Adult Dental and Vision | PPO | 76168DE0700006 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| my Blue Access WV Major Events PPO Catastrophic 9200 - 3 Free PCP Visits | PPO | 31274WV0560010 | No |
| my Blue Access WV PPO Bronze 3800 | PPO | 31274WV0560001 | No |
| my Blue Access WV PPO Bronze 3800 + Adult Dental and Vision | PPO | 31274WV0570001 | No |
| my Blue Access WV PPO Bronze 7400 HSA - Custom Drug Benefit | PPO | 31274WV0580001 | No |
| my Blue Access WV PPO Bronze 8900 | PPO | 31274WV0560006 | No |
| my Blue Access WV PPO Gold 0 | PPO | 31274WV0560005 | No |
| my Blue Access WV PPO Gold 0 + Adult Dental and Vision | PPO | 31274WV0570003 | No |
| my Blue Access WV PPO Gold 1700 HSA | PPO | 31274WV0580002 | No |
| my Blue Access WV PPO Premier Gold 0 | PPO | 31274WV0590002 | No |
| my Blue Access WV PPO Premier Gold 0 + Adult Dental and Vision | PPO | 31274WV0600002 | No |
| my Blue Access WV PPO Silver 7000 | PPO | 31274WV0560003 | No |
| my Blue Access WV PPO Standard Bronze 7500 | PPO | 31274WV0560007 | No |
| my Blue Access WV PPO Standard Gold 1500 | PPO | 31274WV0560009 | No |
| my Blue Access WV PPO Standard Silver 5000 | PPO | 31274WV0560008 | No |
| my Blue Access WV PPO Standard Silver 5000 + Adult Dental and Vision | PPO | 31274WV0570004 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Blue Connect 80/60 $3200 (L) | POS | 19636LA0240010 | No |
| Blue Connect 80/60 $3200 (N) | POS | 19636LA0240007 | No |
| Blue Connect 80/60 $3200 (S) | POS | 19636LA0240013 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (L) | POS | 19636LA0240027 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (N) | POS | 19636LA0240026 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (S) | POS | 19636LA0240028 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (L) | POS | 19636LA0240024 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (N) | POS | 19636LA0240023 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (S) | POS | 19636LA0240025 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (L) | POS | 19636LA0240021 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (N) | POS | 19636LA0240020 | No |
| Blue Connect Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (S) | POS | 19636LA0240022 | No |
| Blue POS 60/40 $6500 | POS | 19636LA0220012 | No |
| Blue POS 70/50 $4550 | POS | 19636LA0220013 | No |
| Blue POS 80/60 $3200 | POS | 19636LA0220014 | No |
| Blue POS Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan | POS | 19636LA0220017 | No |
| Blue POS Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan | POS | 19636LA0220018 | No |
| Blue POS Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan | POS | 19636LA0220019 | No |
| Blue POS Copay (PCP, Specialist, Urgent Care) 80/60 $1000 | POS | 19636LA0220005 | No |
| Community Blue 80/60 $3200 | POS | 19636LA0230008 | No |
| Community Blue Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan | POS | 19636LA0230011 | No |
| Community Blue Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan | POS | 19636LA0230010 | No |
| Community Blue Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan | POS | 19636LA0230009 | No |
| Precision Blue 80/60 $3200 (BR) | POS | 19636LA0610005 | No |
| Precision Blue 80/60 $3200 (M) | POS | 19636LA0610010 | No |
| Precision Blue Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (BR) | POS | 19636LA0610015 | No |
| Precision Blue Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (M) | POS | 19636LA0610016 | No |
| Precision Blue Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (BR) | POS | 19636LA0610013 | No |
| Precision Blue Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (M) | POS | 19636LA0610014 | No |
| Precision Blue Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (BR) | POS | 19636LA0610011 | No |
| Precision Blue Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (M) | POS | 19636LA0610012 | No |
| Signature Blue 80/60 $3200 | POS | 19636LA0590003 | No |
| Signature Blue Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan | POS | 19636LA0590007 | No |
| Signature Blue Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan | POS | 19636LA0590006 | No |
| Signature Blue Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan | POS | 19636LA0590005 | 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 | 23468OK0200002 | Yes |
| Humana Dental Smart Choice - High | PPO | 31358HI0010002 | Yes |
| Humana Dental Smart Choice - High | PPO | 32237NC0290002 | Yes |
| Humana Dental Smart Choice - High | PPO | 44580AL0380003 | 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 - Lite | PPO | 82120TN0630006 | Yes |
| Humana Dental Smart Choice - Low | PPO | 15980FL0160003 | Yes |
| Humana Dental Smart Choice - Low | PPO | 23468OK0200001 | Yes |
| Humana Dental Smart Choice - Low | PPO | 30613MO0560001 | 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 | 66105AZ0620002 | Yes |
| Humana Dental Smart Choice - Low | PPO | 82120TN0630004 | Yes |
| Humana Dental Smart Choice - Low | PPO | 99791IN0540001 | Yes |
| Humana Dental Smart Choice Basic | PPO | 46958UT0470002 | Yes |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Select by Medica Bronze $0 Copay PCP Visits | EPO | 39520KS0040041 | No |
| Select by Medica Bronze Share | EPO | 39520KS0040029 | No |
| Select by Medica Expanded Bronze Standard | EPO | 39520KS0040073 | No |
| Select by Medica Gold $0 Copay PCP Visits | EPO | 39520KS0040045 | No |
| Select by Medica Gold Share | EPO | 39520KS0040075 | No |
| Select by Medica Gold Standard | EPO | 39520KS0040055 | No |
| Select by Medica Silver $0 Copay PCP Visits | EPO | 39520KS0040074 | No |
| Select by Medica Silver Share | EPO | 39520KS0040076 | No |
| Select by Medica Silver Standard | EPO | 39520KS0040057 | No |
| WellFirst by Medica Bronze $0 Copay PCP Visits | EPO | 47840MO0010021 | No |
| WellFirst by Medica Bronze Share | EPO | 47840MO0010022 | No |
| WellFirst by Medica Catastrophic | EPO | 47840MO0010010 | No |
| WellFirst by Medica Expanded Bronze Standard | EPO | 47840MO0010017 | No |
| WellFirst by Medica Gold $0 Copay PCP Visits | EPO | 47840MO0010019 | No |
| WellFirst by Medica Gold Copay Plus | EPO | 47840MO0010001 | No |
| WellFirst by Medica Gold Standard | EPO | 47840MO0010015 | No |
| WellFirst by Medica Silver $0 Copay PCP Visits | EPO | 47840MO0010020 | No |
| WellFirst by Medica Silver Copay Plus | EPO | 47840MO0010002 | No |
| WellFirst by Medica Silver Standard | EPO | 47840MO0010016 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Bronze $8,300 w/ Virtual & Wellness ON-EX | HMO | 99969OH0080499 | No |
| Bronze HSA $7,300 ON-EX | HMO | 99969OH0080498 | No |
| Bronze Standard w/ Virtual & Wellness | HMO | 99969OH0080500 | No |
| Bronze Standard w/ Virtual & Wellness (CLE-Care) | HMO | 99969OH0080506 | No |
| Gold $1250 w/ Virtual & Wellness ON-EX | HMO | 99969OH0080543 | No |
| Gold $500 w/ Virtual & Wellness ON-EX | HMO | 99969OH0080542 | No |
| Gold Standard w/ Virtual & Wellness | HMO | 99969OH0080492 | No |
| Gold Standard w/ Virtual & Wellness (CLE-CARE) | HMO | 99969OH0080504 | No |
| Silver $5000 w/ Virtual & Wellness ON-EX | HMO | 99969OH0080544 | No |
| Silver Standard w/ Virtual & Wellness | HMO | 99969OH0080496 | No |
| Silver Standard w/ Virtual & Wellness (CLE-Care) | HMO | 99969OH0080505 | No |
| SilverSelect w/ Virtual & Wellness ON-EX | HMO | 99969OH0080495 | No |
| Young Adult Essentials ON-EX | HMO | 99969OH0080503 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Moda Health Affinity Bronze 7750 | EPO | 39424OR1680005 | No |
| Moda Health Affinity Bronze 9000 | EPO | 39424OR1660002 | No |
| Moda Health Affinity Bronze HDHP 7500 | EPO | 39424OR1680007 | No |
| Moda Health Affinity Gold 1000 | EPO | 39424OR1700001 | No |
| Moda Health Affinity Gold 1500 | EPO | 39424OR1680008 | No |
| Moda Health Affinity Gold 250 | EPO | 39424OR1690001 | No |
| Moda Health Affinity Silver 3000 | EPO | 39424OR1690003 | No |
| Moda Health Affinity Silver 3400 | EPO | 39424OR1680002 | No |
| Moda Health Affinity Silver 4500 | EPO | 39424OR1680004 | No |
| Moda Health Affinity Silver 6000 | EPO | 39424OR1660001 | No |
| Moda Health Oregon Standard Bronze Affinity | EPO | 39424OR1670003 | No |
| Moda Health Oregon Standard Gold Affinity | EPO | 39424OR1670001 | No |
| Moda Health Oregon Standard Silver Affinity | EPO | 39424OR1670002 | No |
| Moda Pioneer Alaska Standard Bronze | PPO | 73836AK0960001 | No |
| Moda Pioneer Alaska Standard Gold | PPO | 73836AK0940001 | No |
| Moda Pioneer Alaska Standard Silver | PPO | 73836AK0950001 | No |
| Moda Pioneer Bronze 6500 | PPO | 73836AK0930003 | No |
| Moda Pioneer Bronze HDHP 5500 | PPO | 73836AK0970002 | No |
| Moda Pioneer Gold 1500 | PPO | 73836AK0930001 | No |
| Moda Pioneer Silver 4500 | PPO | 73836AK0930002 | No |
| Moda Select Bronze 8700 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010006 | No |
| Moda Select Bronze HDHP 7500 | EPO | 17933TX0010007 | No |
| Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010001 | No |
| Moda Select Gold 1800 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010002 | No |
| Moda Select Silver 3500 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010003 | No |
| Moda Select Silver 4800 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010004 | No |
| Moda Select Silver 6400 ($0 Virtual Urgent Care through CirrusMD) | EPO | 17933TX0010005 | No |
| Moda Select Texas Standard Bronze | EPO | 17933TX0010010 | No |
| Moda Select Texas Standard Gold | EPO | 17933TX0010009 | No |
| Moda Select Texas Standard Silver | EPO | 17933TX0010008 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Octave Bronze Exp Standardized | POS | 48772AR0010004 | No |
| Octave Bronze Value | POS | 48772AR0010005 | No |
| Octave Gold Standardized | POS | 48772AR0010001 | No |
| Octave Silver AH | POS | 48772AR0010003 | No |
| Octave Silver Classic Suitcase | POS | 48772AR0010006 | No |
| Octave Silver Standardized | POS | 48772AR0010002 | 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? |
|---|---|---|---|
| Essential Bronze 6500 | POS | 14624MS0010001 | No |
| Essential Gold 1500 | POS | 14624MS0010002 | No |
| Freedom Silver 4000 | POS | 14624MS0010004 | No |
| Savings Bronze 7700 | POS | 14624MS0010006 | No |
| Standard Bronze 7500 | POS | 14624MS0010009 | No |
| Standard Gold 1500 | POS | 14624MS0010007 | No |
| Standard Silver 5000 | POS | 14624MS0010008 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| MyPriority Balanced Silver | HMO | 29698MI0541020 | No |
| MyPriority Balanced Silver Bronson Healthcare Partners | HMO | 29698MI0541022 | No |
| MyPriority Balanced Silver Corewell Health West Michigan Network | HMO | 29698MI0541021 | No |
| MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) | HMO | 29698MI0541037 | No |
| MyPriority Balanced Silver Southeast Michigan Network | HMO | 29698MI0541023 | No |
| MyPriority Balanced Silver Trinity Health East Network | HMO | 29698MI0541025 | No |
| MyPriority Enhanced Gold Bronson Healthcare Partners | HMO | 29698MI0540596 | No |
| MyPriority Enhanced Gold Corewell Health West Michigan Network | HMO | 29698MI0540595 | No |
| MyPriority Enhanced Gold Corewell Health West Michigan Network (Allegan, Barry) | HMO | 29698MI0540742 | No |
| MyPriority Enhanced Gold Southeast Michigan Network | HMO | 29698MI0540597 | No |
| MyPriority Enhanced Gold Trinity Health East Network | HMO | 29698MI0540599 | No |
| MyPriority Premier Silver | HMO | 29698MI0541060 | No |
| MyPriority Premier Silver Bronson Healthcare Partners | HMO | 29698MI0541062 | No |
| MyPriority Premier Silver Corewell Health West Michigan Network | HMO | 29698MI0541061 | No |
| MyPriority Premier Silver Corewell Health West Michigan Network (Allegan, Barry) | HMO | 29698MI0541039 | No |
| MyPriority Premier Silver Southeast Michigan Network | HMO | 29698MI0541063 | No |
| MyPriority Premier Silver Trinity Health East Network | HMO | 29698MI0541065 | No |
| MyPriority Standard Bronze | HMO | 29698MI0541100 | No |
| MyPriority Standard Bronze - Bronson Healthcare Partners | HMO | 29698MI0541102 | No |
| MyPriority Standard Bronze - Corewell Health West Michigan Network | HMO | 29698MI0541101 | No |
| MyPriority Standard Bronze - Corewell Health West Michigan Network (Allegan, Barry) | HMO | 29698MI0541143 | No |
| MyPriority Standard Bronze - Southeast Michigan Network | HMO | 29698MI0541103 | No |
| MyPriority Standard Bronze - Travel | HMO | 29698MI0541106 | No |
| MyPriority Standard Bronze - Trinity Health East Network | HMO | 29698MI0541105 | No |
| MyPriority Standard Gold | HMO | 29698MI0541120 | No |
| MyPriority Standard Gold Bronson Healthcare Partners | HMO | 29698MI0541122 | No |
| MyPriority Standard Gold Corewell Health West Michigan Network | HMO | 29698MI0541121 | No |
| MyPriority Standard Gold Corewell Health West Michigan Network (Allegan, Barry) | HMO | 29698MI0541145 | No |
| MyPriority Standard Gold Southeast Michigan Network | HMO | 29698MI0541123 | No |
| MyPriority Standard Gold Trinity Health East Network | HMO | 29698MI0541125 | No |
| MyPriority Standard Silver | HMO | 29698MI0541110 | No |
| MyPriority Standard Silver - Bronson Healthcare Partners | HMO | 29698MI0541112 | No |
| MyPriority Standard Silver - Corewell Health West Michigan Network | HMO | 29698MI0541111 | No |
| MyPriority Standard Silver - Corewell Health West Michigan Network (Allegan, Barry) | HMO | 29698MI0541144 | No |
| MyPriority Standard Silver - Southeast Michigan Network | HMO | 29698MI0541113 | No |
| MyPriority Standard Silver - Travel | HMO | 29698MI0541116 | No |
| MyPriority Standard Silver - Trinity Health East Network | HMO | 29698MI0541115 | No |
| MyPriority Value Bronze | HMO | 29698MI0541010 | No |
| MyPriority Value Bronze Bronson Healthcare Partners | HMO | 29698MI0541012 | No |
| MyPriority Value Bronze Corewell Health West Michigan Network | HMO | 29698MI0541011 | No |
| MyPriority Value Bronze Corewell Health West Michigan Network (Allegan, Barry) | HMO | 29698MI0541036 | No |
| MyPriority Value Bronze HSA | HMO | 29698MI0541000 | No |
| MyPriority Value Bronze HSA Bronson Healthcare Partners | HMO | 29698MI0541002 | No |
| MyPriority Value Bronze HSA Corewell Health West Michigan Network | HMO | 29698MI0541001 | No |
| MyPriority Value Bronze HSA Corewell Health West Michigan Network (Allegan, Barry) | HMO | 29698MI0541035 | No |
| MyPriority Value Bronze HSA Southeast Michigan Network | HMO | 29698MI0541003 | No |
| MyPriority Value Bronze HSA Trinity Health East Network | HMO | 29698MI0541005 | No |
| MyPriority Value Bronze Southeast Michigan Network | HMO | 29698MI0541013 | No |
| MyPriority Value Bronze Trinity Health East Network | HMO | 29698MI0541015 | 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? |
|---|---|---|---|
| Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible | HMO | 71837TX0010022 | No |
| Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible | HMO | 71837TX0010022 | No |
| Sendero Health Capital Silver / $40 PCP / $80 Specialist / $20 Generic Drugs | HMO | 71837TX0010017 | No |
| Sendero Health Capital Silver / $40 PCP / $80 Specialist / $20 Generic Drugs | HMO | 71837TX0010017 | No |
| Sendero Health Hill Country Gold / $30 PCP / $60 Specialist / $15 Generic Drugs | HMO | 71837TX0010018 | No |
| Sendero Health Hill Country Gold / $30 PCP / $60 Specialist / $15 Generic Drugs | HMO | 71837TX0010018 | No |
| Sendero Health Original Silver / $20 PCP + 2 $0 PCP Visits / $10 Generic Drugs | HMO | 71837TX0010001 | No |
| Sendero Health Original Silver / $20 PCP + 2 $0 PCP Visits / $10 Generic Drugs | HMO | 71837TX0010001 | No |
| Sendero Health Preferred Bronze / $25 PCP / $75 Specialist / $22 Generic Drugs | HMO | 71837TX0010008 | No |
| Sendero Health Preferred Bronze / $25 PCP / $75 Specialist / $22 Generic Drugs | HMO | 71837TX0010008 | No |
| Sendero Health Quality Care Bronze High Deductible / $50 PCP / $25 Generic Drugs / $100 Specialist | HMO | 71837TX0010020 | No |
| Sendero Health Quality Care Bronze High Deductible / $50 PCP / $25 Generic Drugs / $100 Specialist | HMO | 71837TX0010020 | No |
| Sendero Health Real Gold / $350 Deductible | HMO | 71837TX0010002 | No |
| Sendero Health Real Gold / $350 Deductible | HMO | 71837TX0010002 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| SummaCare Bronze 8000 | HMO | 52664OH1530023 | No |
| SummaCare Bronze 9200 with 3 Free PCP Visits | HMO | 52664OH1530022 | No |
| SummaCare Gold 2000 with 3 Free PCP Visits | HMO | 52664OH1530026 | No |
| SummaCare Silver 5000 1000 Rx with 3 Free PCP Visits | HMO | 52664OH1530025 | No |
| SummaCare Silver 7000 with 3 Free PCP Visits | HMO | 52664OH1530030 | No |
| SummaCare Standard Bronze | HMO | 52664OH1530032 | No |
| SummaCare Standard Gold | HMO | 52664OH1530036 | No |
| SummaCare Standard Silver | HMO | 52664OH1530035 | 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 |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| University of Michigan Health Plan HMO Exclusive Bronze | HMO | 60829MI0190030 | No |
| University of Michigan Health Plan HMO Exclusive Bronze HSA | HMO | 60829MI0220002 | No |
| University of Michigan Health Plan HMO Exclusive Bronze Standard | HMO | 60829MI0190034 | No |
| University of Michigan Health Plan HMO Exclusive Catastrophic | HMO | 60829MI0190026 | No |
| University of Michigan Health Plan HMO Exclusive Gold Classic | HMO | 60829MI0190009 | No |
| University of Michigan Health Plan HMO Exclusive Gold Select | HMO | 60829MI0190016 | No |
| University of Michigan Health Plan HMO Exclusive Gold Standard | HMO | 60829MI0190032 | No |
| University of Michigan Health Plan HMO Exclusive Silver | HMO | 60829MI0190017 | No |
| University of Michigan Health Plan HMO Exclusive Silver Select Plus | HMO | 60829MI0190020 | No |
| University of Michigan Health Plan HMO Exclusive Silver Standard | HMO | 60829MI0190033 | No |
| Plan Name | Plan Type | Plan ID | Dental Only Plan? |
|---|---|---|---|
| Standard Expanded Bronze WellCare | PPO | 44007NC0120004 | No |
| Standard Gold WellCare | PPO | 44007NC0120006 | No |
| Standard Silver WellCare | PPO | 44007NC0120005 | No |