Personal ChoiceGroups 100+

Forms are in pdf format.

Option PCP Copay
Personal Choice 5 $5
Personal Choice 5-15-70 $5
Personal Choice 10 $10
Personal Choice 210 $10
Personal Choice 310 $10
Personal Choice 10-20-70 $10
Personal Choice 15 $15
Personal Choice 15-25-70 $15
Personal Choice 20 $20
Personal Choice 320 $20
Personal Choice 20-30-70 $20
Flex PPO C1-F1-O1 $10
Flex PPO C1-F1-O2 $10
Flex PPO C1-F2-O1 $10
Flex PPO C1-F2-O2 $10
Flex PPO C1-F3-O1 $10
Flex PPO C1-F3-O2 $10
Flex PPO C1-F4-O1 $10
Flex PPO C1-F4-O2 $10
Flex PPO C2-F1-O1 $15
Flex PPO C2-F1-O2 $15
Flex PPO C2-F2-O1 $15
Flex PPO C2-F2-O2 $15
Flex PPO C2-F3-O1 $15
Flex PPO C2-F3-O2 $15
Flex PPO C2-F4-O1 $15
Flex PPO C2-F4-O2 $15
Flex PPO C3-F1-O1 $20
Flex PPO C3-F1-O2 $20
Flex PPO C3-F2-O1 $20
Flex PPO C3-F3-O2 $20
Flex PPO C3-F4-O1 $20
Flex PPO C3-F5-O2 $20
Flex PPO C4-F3-O1 $30
Flex PPO C4-F3-O2 $30
Flex PPO C4-F4-O1 $30
Flex PPO C4-F4-O2 $30
Flex PPO C4-F5-O2 $30
Personal Choice D1-N1 $20
Personal Choice D1-N2 $20
Personal Choice D2-N1 $20
Personal Choice D2-N2 $20
Personal Choice D3-N1 $20
Personal Choice D3-N2 $20
Personal Choice D4-N1 $20
Personal Choice D4-N2 $20
Personal Choice HDHP HD1-HC1 — Calendar Year 100%*
Personal Choice HDHP HD1-HC1 — Contract Year 100%*
Personal Choice HDHP HD1-HC2 — Calendar Year 80%*
Personal Choice HDHP HD1-HC2 — Contract Year 80%*
Personal Choice HDHP HD2-HC1 — Calendar Year 100%*
Personal Choice HDHP HD2-HC1 — Contract Year 100%*
Personal Choice HDHP HD2-HC2 — Calendar Year 80%*
Personal Choice HDHP HD2-HC2 — Contract Year 80%*
Personal Choice HDHP HD3-HC1 — Calendar Year 100%*
Personal Choice HDHP HD3-HC1 — Contract Year 100%*
Personal Choice HDHP HD3-HC2 — Calendar Year 80%*
Personal Choice HDHP HD3-HC2 — Contract Year 80%*
Personal Choice HDHP HD4-HC1 — Calendar Year 100%*
Personal Choice HDHP HD4-HC1 — Contract Year 100%*
Personal Choice HDHP HD4-HC2 — Calendar Year 80%*
Personal Choice HDHP HD4-HC2 — Contract Year 80%*

*after deductible