$0
$0
$25
$25
$3,600 Per Year
$3,600 Per Year
$3,600 Per Year
$3,600 Per Year
$0
$0
$0
$0
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$30 Copay
$30 Copay
$30 Copay
$30 Copay
$60 Copay
$60 Copay
$60 Copay
$60 Copay
$90 Copay
$90 Copay
$90 Copay
$90 Copay
$10 Copay
$10 Copay
$10 Copay
$10 Copay
100% Coverage
100% Coverage
100% Coverage
100% Coverage
$20 Copay
$20 Copay
$20 Copay
$20 Copay
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
$150 Copay
$150 Copay
$150 Copay
$150 Copay
$100 Copay
$100 Copay
$100 Copay
$100 Copay
Preferred Pharmacies - $0
Other Network Pharmacies - $0
Preferred Pharmacies - $0
Other Network Pharmacies - $0
Preferred Pharmacies - $0
Other Network Pharmacies - $0
Preferred Pharmacies - $0
Other Network Pharmacies - $0
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $5 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $5 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $5 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $5 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $10 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $10 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $10 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $10 Copay*
Preferred Pharmacies - $40 Copay*
Other Network Pharmacies - $45 Copay*
Preferred Pharmacies - $40 Copay*
Other Network Pharmacies - $45 Copay*
Preferred Pharmacies - $40 Copay*
Other Network Pharmacies - $45 Copay*
Preferred Pharmacies - $40 Copay*
Other Network Pharmacies - $45 Copay*
Preferred Pharmacies - $90 Copay*
Other Network Pharmacies - $95 Copay*
Preferred Pharmacies - $90 Copay*
Other Network Pharmacies - $95 Copay*
Preferred Pharmacies - $90 Copay*
Other Network Pharmacies - $95 Copay*
Preferred Pharmacies - $90 Copay*
Other Network Pharmacies - $95 Copay*
Preferred Pharmacies - 33% Co-insurance
Other Network Pharmacies - 33% Co-insurance
Preferred Pharmacies - 33% Co-insurance
Other Network Pharmacies - 33% Co-insurance
Preferred Pharmacies - 33% Co-insurance
Other Network Pharmacies - 33% Co-insurance
Preferred Pharmacies - 33% Co-insurance
Other Network Pharmacies - 33% Co-insurance
Preferred Pharmacies - $4,660 Per Year
Other Network Pharmacies - $4,660 Per Year
Preferred Pharmacies - $4,660 Per Year
Other Network Pharmacies - $4,660 Per Year
Preferred Pharmacies - $4,660 Per Year
Other Network Pharmacies - $4,660 Per Year
Preferred Pharmacies - $4,660 Per Year
Other Network Pharmacies - $4,660 Per Year
As a member of the PHP Advantage and PHP Advantage Plus plans, you’ll have low, predictable copays on Select Insulins through our Insulin Savings Program.* Costs for Select Insulins will remain the same during the Initial Coverage and Coverage Gap phases of your prescription drug benefit. The program doesn’t apply during the Catastrophic Coverage stage. Note that this program isn’t available if you receive Extra Help from the government.
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
30-Day Supply: $35 copay
30-Day Supply: $35 copay
30-Day Supply: $35 copay
$0 Copay for routine eye exam
Our plan pays up to $200 every calendar year for eyeglass frames, lenses and lens options, or contact lenses.
$0 Copay for routine eye exam
Our plan pays up to $200 every calendar year for eyeglass frames, lenses and lens options, or contact lenses.
$0 Copay for routine eye exam
Our plan pays up to $400 every calendar year for eyeglass frames, lenses and lens options, or contact lenses.
$0 Copay for routine eye exam
Our plan pays up to $400 every calendar year for eyeglass frames, lenses and lens options, or contact lenses.
Oral Exams - $0 Copay (two per calendar year)
Oral Exams - $0 Copay (two per calendar year)
Oral Exams - $0 Copay (two per calendar year)
$1,750 maximum benefit per year (combined preventive and comprehensive)
Oral Exams - $0 Copay (two per calendar year)
$1,750 maximum benefit per year (combined preventive and comprehensive)
$30 Copay for Medicare-covered services**
$30 Copay for Medicare-covered services**
$30 Copay for Medicare-covered services**
$100 Deductible
$1,750 maximum benefit per year (combined preventive and comprehensive)
$30 Copay for Medicare-covered services**
$100 Deductible
$1,750 maximum benefit per year (combined preventive and comprehensive)
$64 Per Quarter
Up to 2 orders per quarter; no rollovers
$64 Per Quarter
Up to 2 orders per quarter; no rollovers
$89 Per Quarter
Up to 2 orders per quarter; no rollovers
$89 Per Quarter
Up to 2 orders per quarter; no rollovers
$25 Copay for hearing exam
$1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)
$25 Copay for hearing exam
$1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)
$25 Copay for hearing exam
$1,500 allowance for up to 2 hearing aids every 2 years (both ears combined)
$25 Copay for hearing exam
$1,500 allowance for up to 2 hearing aids every 2 years (both ears combined)
$0 Copay for 20 one-way trips to approved locations per year
$0 Copay for 20 one-way trips to approved locations per year
$0 Copay for 30 one-way trips to approved locations per year
$0 Copay for 30 one-way trips to approved locations per year
SilverSneakers<span style="vertical-align: super; font-size: 10px;">®</span> included at no cost
SilverSneakers<span style="vertical-align: super; font-size: 10px;">®</span> included at no cost
SilverSneakers<span style="vertical-align: super; font-size: 10px;">®</span> included at no cost
SilverSneakers<span style="vertical-align: super; font-size: 10px;">®</span> included at no cost
Emergency or urgent care coverage if you are making a trip out of state or country
Emergency or urgent care coverage if you are making a trip out of state or country
Emergency or urgent care coverage if you are making a trip out of state or country
Emergency or urgent care coverage if you are making a trip out of state or country
28 meals, (2 meals/day for 14 days) delivered to the home after each discharge - (limited to 2 discharges annually)
28 meals, (2 meals/day for 14 days) delivered to the home after each discharge - (limited to 2 discharges annually)
28 meals, (2 meals/day for 14 days) delivered to the home after each discharge - (limited to 2 discharges annually)
28 meals, (2 meals/day for 14 days) delivered to the home after each discharge - (limited to 2 discharges annually)
$0
$0
$25
$25
$2,900 Per Year
$2,900 Per Year
$2,900 Per Year
$2,900 Per Year
$0
$0
$0
$0
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$0 Copay
$30 Copay
$30 Copay
$30 Copay
$30 Copay
$60 Copay
$60 Copay
$60 Copay
$60 Copay
$90 Copay
$90 Copay
$90 Copay
$90 Copay
$10 Copay
$10 Copay
$10 Copay
$10 Copay
100% Coverage
100% Coverage
100% Coverage
100% Coverage
$20 Copay
$20 Copay
$20 Copay
$20 Copay
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
$200 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond
$150 Copay
$150 Copay
$150 Copay
$150 Copay
$100 Copay
$100 Copay
$100 Copay
$100 Copay
Preferred Pharmacies - $0
Other Network Pharmacies - $0
Preferred Pharmacies - $0
Other Network Pharmacies - $0
Preferred Pharmacies - $0
Other Network Pharmacies - $0
Preferred Pharmacies - $0
Other Network Pharmacies - $0
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $5 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $5 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $5 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $5 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $10 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $10 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $10 Copay*
Preferred Pharmacies - $0 Copay*
Other Network Pharmacies - $10 Copay*
Preferred Pharmacies - $40 Copay*
Other Network Pharmacies - $45 Copay*
Preferred Pharmacies - $40 Copay*
Other Network Pharmacies - $45 Copay*
Preferred Pharmacies - $40 Copay*
Other Network Pharmacies - $45 Copay*
Preferred Pharmacies - $40 Copay*
Other Network Pharmacies - $45 Copay*
Preferred Pharmacies - $90 Copay*
Other Network Pharmacies - $95 Copay*
Preferred Pharmacies - $90 Copay*
Other Network Pharmacies - $95 Copay*
Preferred Pharmacies - $90 Copay*
Other Network Pharmacies - $95 Copay*
Preferred Pharmacies - $90 Copay*
Other Network Pharmacies - $95 Copay*
Preferred Pharmacies - 33% Co-insurance
Other Network Pharmacies - 33% Co-insurance
Preferred Pharmacies - 33% Co-insurance
Other Network Pharmacies - 33% Co-insurance
Preferred Pharmacies - 33% Co-insurance
Other Network Pharmacies - 33% Co-insurance
Preferred Pharmacies - 33% Co-insurance
Other Network Pharmacies - 33% Co-insurance
Preferred Pharmacies - $4,660 Per Year
Other Network Pharmacies - $4,660 Per Year
Preferred Pharmacies - $4,660 Per Year
Other Network Pharmacies - $4,660 Per Year
Preferred Pharmacies - $4,660 Per Year
Other Network Pharmacies - $4,660 Per Year
Preferred Pharmacies - $4,660 Per Year
Other Network Pharmacies - $4,660 Per Year
As a member of the PHP Advantage and PHP Advantage Plus plans, you’ll have low, predictable copays on Select Insulins through our Insulin Savings Program.* Costs for Select Insulins will remain the same during the Initial Coverage and Coverage Gap phases of your prescription drug benefit. The program doesn’t apply during the Catastrophic Coverage stage. Note that this program isn’t available if you receive Extra Help from the government.
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
30-Day Supply: $35 copay
30-Day Supply: $35 copay
30-Day Supply: $35 copay
30-Day Supply: $35 copay
$0 Copay for routine eye exam
Our plan pays up to $200 every calendar year for eyeglass frames, lenses and lens options, or contact lenses.
$0 Copay for routine eye exam
Our plan pays up to $200 every calendar year for eyeglass frames, lenses and lens options, or contact lenses.
$0 Copay for routine eye exam
Our plan pays up to $400 every calendar year for eyeglass frames, lenses and lens options, or contact lenses.
$0 Copay for routine eye exam
Our plan pays up to $400 every calendar year for eyeglass frames, lenses and lens options, or contact lenses.
Oral Exams - $0 Copay (two per calendar year)
Oral Exams - $0 Copay (two per calendar year)
Oral Exams - $0 Copay (two per calendar year)
$1,750 maximum benefit per year (combined preventive and comprehensive)
Oral Exams - $0 Copay (two per calendar year)
$1,750 maximum benefit per year (combined preventive and comprehensive)
$30 Copay for Medicare-covered services**
$30 Copay for Medicare-covered services**
$30 Copay for Medicare-covered services**
$100 Deductible
$1,750 maximum benefit per year (combined preventive and comprehensive)
$30 Copay for Medicare-covered services**
$100 Deductible
$1,750 maximum benefit per year (combined preventive and comprehensive)
$64 Per Quarter
Up to 2 orders per quarter; no rollovers
$64 Per Quarter
Up to 2 orders per quarter; no rollovers
$89 Per Quarter
Up to 2 orders per quarter; no rollovers
$89 Per Quarter
Up to 2 orders per quarter; no rollovers
$25 Copay for hearing exam
$1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)
$25 Copay for hearing exam
$1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)
$25 Copay for hearing exam
$1,500 allowance for up to 2 hearing aids every 2 years (both ears combined)
$25 Copay for hearing exam
$1,500 allowance for up to 2 hearing aids every 2 years (both ears combined)
$0 Copay for 20 one-way trips to approved locations per year
$0 Copay for 20 one-way trips to approved locations per year
$0 Copay for 30 one-way trips to approved locations per year
$0 Copay for 30 one-way trips to approved locations per year
SilverSneakers<span style="vertical-align: super; font-size: 10px;">®</span> included at no cost
SilverSneakers<span style="vertical-align: super; font-size: 10px;">®</span> included at no cost
SilverSneakers<span style="vertical-align: super; font-size: 10px;">®</span> included at no cost
SilverSneakers<span style="vertical-align: super; font-size: 10px;">®</span> included at no cost
Emergency or urgent care coverage if you are making a trip out of state or country
Emergency or urgent care coverage if you are making a trip out of state or country
Emergency or urgent care coverage if you are making a trip out of state or country
Emergency or urgent care coverage if you are making a trip out of state or country
28 meals, (2 meals/day for 14 days) delivered to the home after each discharge - (limited to 2 discharges annually)
28 meals, (2 meals/day for 14 days) delivered to the home after each discharge - (limited to 2 discharges annually)
28 meals, (2 meals/day for 14 days) delivered to the home after each discharge - (limited to 2 discharges annually)
28 meals, (2 meals/day for 14 days) delivered to the home after each discharge - (limited to 2 discharges annually)
