Benefit Choice

Plan Options

Copay Option (Separate Medical & Rx Deductibles)

• Outline of Benefits*

• Sample Health and Wellness Benefit Plan*

• Sample Summary of Benefits and Coverage*

Coinsurance Option (Combined Medical & Rx Deductibles)

• Outline of Benefits*

• Sample Health and Wellness Benefit Plan*

• Sample Summary of Benefits and Coverage*

High Deductible Health Plan Option (Combined Medical & Rx Deductibles)

• Outline of Benefits*

• Sample Health and Wellness Benefit Plan*

• Sample Summary of Benefits and Coverage*

*DISCLAIMER: The Health and Wellness Benefit Plan and Summary of Benefits and Coverage are examples of the most popular benefit option and are not guarantees of coverage for a particular benefit. Following enrollment, covered Members will be able to review their chosen benefit plan options in their myBlue account.