Personal Choice — Groups 51+IBC Forms Online — Benefit Summaries

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Option PCP Copay Last Updated
Personal Choice HDHP w/integ Rx - HD1-HC1 Contract Year Summary of Benefits - HCR 100%* 2011-08
Personal Choice HDHP w/integ Rx - HD2-HC1 Contract Year Summary of Benefits - HCR 100%* 2011-08
Personal Choice HDHP w/integ Rx - HD3-HC1 Contract Year Summary of Benefits - HCR 100%* 2011-08
Personal Choice HDHP w/integ Rx - HD4-HC1 Contract Year Summary of Benefits - HCR 100%* 2011-08
Personal Choice HDHP w/integ Rx - HD4-HC2 Contract Year Summary of Benefits - HCR 80%* 2011-08
Personal Choice C1-F1-O1 - HCR $10 2011-08
Personal Choice C2-F2-O1 - HCR $15 2011-08
Personal Choice C3-F4-O1 - HCR $20 2011-08
Personal Choice C4-F5-O2 - HCR $30 2011-09
Personal Choice D2-N1 - HCR $20 2011-08
Personal Choice D3-N1 - HCR $20 2011-08
Personal Choice D4-N2 - HCR $20 2011-08
Personal Choice HDHP Plus 1A w/Integ Rx 100%* 2011-10
Personal Choice HDHP Plus 2A w/Integ Rx 100%* 2011-10
Personal Choice HDHP Plus 3A w/Integ Rx 100%* 2011-10
Personal Choice HDHP Plus 4A w/Integ Rx 100%* 2011-10
Personal Choice HDHP Plus 5A w/Integ Rx 100%* 2011-10
Personal Choice PPO Plus 10A w/Integ Rx $40 2012-02
Personal Choice PPO Plus 1A $10 2011-10
Personal Choice PPO Plus 2A $15 2011-10
Personal Choice PPO Plus 3A $20 2011-10
Personal Choice PPO Plus 4A $30 2011-10
Personal Choice PPO Plus 5A $20 2011-10
Personal Choice PPO Plus 6A $35 2011-10
Personal Choice PPO Plus 7A $20 2011-10
Personal Choice PPO Plus 8A w/Integ Rx $30 2012-02
Personal Choice PPO Plus 9A w/Integ Rx $40 2012-02
*after deductible