Personal Choice — HCR 100% Preventive Options: Groups 51+IBC Forms Online — Benefit Summaries

Notice!

Benefit summaries have been updated to reflect 100% Preventive values in alignment with Health Care Reform.

PDF icon Forms are in pdf format.

Option PCP Copay Last Updated
Personal Choice 15 $15 2011-08
Personal Choice 10-20-70 $10 2011-08
Personal Choice 10 $10 2011-08
Personal Choice 15-25-70 $15 2011-08
Personal Choice 20-30-70 $20 2011-08
Personal Choice 20 $20 2011-08
Personal Choice 210 $10 2011-08
Personal Choice 310 $10 2011-08
Personal Choice 320 $20 2011-08
Personal Choice 5-15-70 $ 5 2011-08
Personal Choice 5 $ 5 2011-08
Flex PPO C1-F1-O1 $10 2011-08
Flex PPO C1-F1-O2 $10 2011-08
Flex PPO C1-F2-O1 $10 2011-08
Flex PPO C1-F2-O2 $10 2011-08
Flex PPO C1-F3-O1 $10 2011-08
Flex PPO C1-F3-O2 $10 2011-08
Flex PPO C1-F4-O1 $10 2011-08
Flex PPO C1-F4-O2 $10 2011-08
Flex PPO C2-F1-O1 $15 2011-08
Flex PPO C2-F1-O2 $15 2011-08
Flex PPO C2-F2-O1 $15 2011-08
Flex PPO C2-F2-O2 $20 2011-09
Flex PPO C2-F3-01 $20 2011-10
Flex PPO C2-F3-O2 $20 2011-09
Flex PPO C2-F4-O1 $15 2011-08
Flex PPO C2-F4-O2 $15 2011-08
Flex PPO C3-F1-O1 $20 2011-08
Flex PPO C3-F1-O2 $20 2011-08
Flex PPO C3-F2-O1 $20 2011-08
Flex PPO C3-F3-O2 $20 2011-09
Flex PPO C3-F4-O1 $20 2011-08
Flex PPO C3-F5-O2 $20 2011-08
Flex PPO C4-F3-O1 $30 2011-08
Flex PPO C4-F3-O2 $30 2011-08
Flex PPO C4-F4-O1 $30 2011-08
Flex PPO C4-F4-O2 $30 2011-08
Flex PPO C4-F5-O2 $30 2011-08
Personal Choice D1-N1 $20 2011-08
Personal Choice D1-N2 $20 2011-08
Personal Choice D2-N1 $20 2011-08
Personal Choice D2-N2 $20 2011-08
Personal Choice D3-N1 $20 2011-08
Personal Choice D3-N2 $20 2011-08
Personal Choice D4-N1 $20 2011-08
Personal Choice HDHP HD1-HC1 - Calendar Year $ 0* 2011-08
Personal Choice HDHP HD1-HC1 - Contract Year $ 0* 2011-08
Personal Choice HDHP HD1-HC1 - Calendar Year $ 0* 2011-08
Personal Choice HDHP HD1-HC1 - Contract Year $ 0* 2011-08
Personal Choice HDHP HD1-HC2 - Calendar Year 20%* 2011-08
Personal Choice HDHP HD1-HC2 - Contract Year 20%* 2011-08
Personal Choice HDHP HD1-HC2 - Calendar Year 20%* 2011-08
Personal Choice HDHP HD1-HC2 - Contract Year 20%* 2011-08
Personal Choice HDHP HD2-HC1 - Calendar Year $ 0* 2011-08
Personal Choice HDHP HD2-HC1 - Contract Year $ 0* 2011-08
Personal Choice HDHP HD2-HC1 - Calendar Year $ 0* 2011-08
Personal Choice HDHP HD2-HC1 - Contract Year $ 0* 2011-08
Personal Choice HDHP HD2-HC2 - Calendar Year 20%* 2011-08
Personal Choice HDHP HD2-HC2 - Contract Year 20%* 2011-08
Personal Choice HDHP HD2-HC2 - Calendar Year 20%* 2011-08
Personal Choice HDHP HD2-HC2 - Contract Year 20%* 2011-08
Personal Choice HDHP HD3-HC1 - Calendar Year $ 0* 2011-08
Personal Choice HDHP HD3-HC1 - Contract Year $ 0* 2011-08
Personal Choice HDHP HD3-HC1 - Calendar Year $ 0* 2011-08
Personal Choice HDHP HD3-HC1 - Contract Year $ 0* 2011-08
Personal Choice HDHP HD3-HC2 - Calendar Year 80%* 2011-08
Personal Choice HDHP HD3-HC2 - Contract Year 20%* 2011-08
Personal Choice HDHP HD3-HC2 - Calendar Year 80%* 2011-08
Personal Choice HDHP HD3-HC2 - Contract Year 80%* 2011-08
Personal Choice HDHP HD4-HC1 - Calendar Year 100%* 2011-08
Personal Choice HDHP HD4-HC1 - Contract Year 100%* 2011-08
Personal Choice HDHP HD4-HC1 - Calendar Year 100%* 2011-09
Personal Choice HDHP HD4-HC1 - Contract Year 100%* 2011-09
Personal Choice HDHP HD4-HC2 - Calendar Year 100%* 2011-08
Personal Choice HDHP HD4-HC2 - Contract Year 80%* 2011-08
Personal Choice HDHP HD4-HC2 - Calendar Year 80%* 2011-03
Flex PPO C3-F3-O1 $20 2011-11
Personal Choice D4-N2 $20 2011-09
*after deductible