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Prescription Benefit Summaries: Freestanding — Groups 51+IBC Forms Online
The Prescription Benefit Summaries: Freestanding section provides a comprehensive list of Independence Blue Cross prescription benefit summaries for you to access. Select the desired plan to view the available benefits summaries.
Forms are in pdf format.
| Option | Last Updated |
|---|---|
| 00/20%/000 | 2007-04 |
| 50/20%/000 | 2007-04 |
| 50/30%/000 | 2007-04 |
| 00/20%/000 | 2007-04 |
| 00/30%/000 | 2007-04 |
| 50/20%/000 | 2007-04 |
| $250/$20/$40/$60 | 2009-04 |
| $250/$5/$40/$60 | 2009-04 |
| $500/$15/$50/$75 | 2009-04 |
| $5/$40/$60 | 2009-04 |
