Prescription Benefit Summaries — Groups 2–50IBC Forms Online

The Prescription Benefit Summaries 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.

PDF icon Forms are in pdf format.

Option	Last Updated
PC Select Rx Rider $10/$45/$75 w/ Orals	2011-10
PC Select Rx Rider $250/$10/$45/$75 w/ Orals	2011-10
PC Select Rx Rider $10/$20/$35 w/ Orals - HCR	2010-12
HMO-POS Select Rx Rider $10/$20/$35 w/ Orals - HCR	2011-02
HMO-POS Select Rx Rider $250/$20/$40/$60 w/ Orals - HCR	2011-02
HMO-POS Standard Rx $ 4 Generic Only w/ Orals - HCR	2011-02
HMO-POS Select Rx Rider $7/50%/$125 w/ Orals - HCR	2011-02
PC Standard $7/50%/$125 w/Orals - HCR	2011-02
HMO-POS Select Rx Rider $10/$40/$70 w/ Orals	2011-08
HMO-POS Select Rx Rider $10/$45/$75 w/ Orals	2011-07
HMO-POS Select Rx Rider $250/$10/$45/$75 w/ Orals	2011-07
PC Select Rx Rider $10/$40/$70 w/ Orals	2011-10
HMO-POS Select Rx Rider $10/$40/$70 w/ Orals	2011-06