Prescription Benefit Summaries: HMO/POS/DPOSGroups 51 – 99

Standard | Select

Forms are in pdf format.

Blue Solutions

Option
HMO-POS Standard Rx $10/$20 w/Oral
HMO-POS Standard Rx $2/$6 w/Oral
HMO-POS Standard Rx $3/$5 w/Oral
HMO-POS Standard Rx $1/$1 w/Oral
HMO-POS Standard Rx $5/$5 w/Oral
HMO-POS Standard Rx $10/$10 w/Oral
HMO-POS Standard Rx $15/$15 w/Oral
HMO-POS Standard Rx $4/$8 w/Oral
HMO-POS Standard Rx $5/$20 w/Oral
HMO-POS Standard Rx $6/$10 w/Oral
HMO-POS Standard Rx $8/$14 w/Oral
HMO-POS Standard Rx $1/$3 w/Oral
HMO-POS Standard Rx 50% w/Oral
HMO-POS Standard Rx $10/$15 w/Oral
HMO-POS Standard Rx $0/$0 w/Oral
HMO/POS Prescription Drug Program $7/50%/$125 w/ Orals
HMO/POS Standard Rx $4 Generic Only w/ Orals
HMO/POS Prescription Drug Program $7/50%/$250 w/ Orals
HMO/POS Standard Rx $7 Generic Only w/ Orals

Blue Solutions Choice

Option
BC HMO/POS Standard $7/50%