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  • General
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  • Individuals and Families (2025)
  • Individuals and Families (2024)
  • Blue Solutions: Small Employer (2025)
  • Blue Solutions: Small Employer (2024)
  • Large Group Options 51-99 (2025)
    • POS
    • DPOS
    • Personal Choice/PPO
    • Rx-Freestanding/Rider
    • Vision
    • Dental
  • Large Group Options 51-99 (2024)
  • Large Group Options 100+ (2025)
  • Large Group Options 100+ (2024)

Prescription Benefit Summaries 2025: Freestanding/RiderGroups 51 – 99

Forms are in pdf format.

Drug Plan Design
Option
Freestanding
Value Rx $3/$15/$35/$50/50% up to $500
Freestanding
Value Rx $3/$20/$40/$60/50% up to $500
Freestanding
Value Rx $3/$25/$50/$75/50% up to $500
Rider
Value Rx $3/$15/$35/$50/50% up to $500
Rider
Value Rx $3/$20/$40/$60/50% up to $500
Rider
Value Rx $3/$25/$50/$75/50% up to $500

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Independence Blue Cross is a subsidiary of Independence Health Group, Inc. ‐ independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.