All PDFs
Flex PC Copay Options
(may be paired with any Personal Choice Rx option)
Flex Personal Choice C1-F1-O1
Flex Personal Choice C1-F1-O2
Flex Personal Choice C1-F2-O1
Flex Personal Choice C1-F2-O2
Flex Personal Choice C1-F3-O1
Flex Personal Choice C1-F3-O2
Flex Personal Choice C1-F4-O1
Flex Personal Choice C1-F4-O2
Flex Personal Choice C2-F1-O1
Flex Personal Choice C2-F1-O2
Flex Personal Choice C2-F2-O1
Flex Personal Choice C2-F2-O2
Flex Personal Choice C2-F3-O1
Flex Personal Choice C2-F3-O2
Flex Personal Choice C2-F4-O1
Flex Personal Choice C2-F4-O2
Flex Personal Choice C3-F1-O1
Flex Personal Choice C3-F1-O2
Flex Personal Choice C3-F2-O1
Flex Personal Choice C3-F2-O2
Flex Personal Choice C3-F3-O1
Flex Personal Choice C3-F3-O2
Flex Personal Choice C3-F4-O1
Flex Personal Choice C3-F4-O2
Flex Personal
Choice C3-F5-O2 (effective 7/1/2007)
Flex Personal
Choice C4-F3-O1 (effective 7/1/2007)
Flex Personal
Choice C4-F3-O2 (effective 7/1/2007)
Flex Personal
Choice C4-F4-O1 (effective 7/1/2007)
Flex Personal
Choice C4-F4-O2 (effective 7/1/2007)
Flex Personal
Choice C4-F5-O2 (effective 7/1/2007)
Flex Deductible PC Options
(may be paired with Personal Choice Rx options 5, 6, 7, 8 or 9 only)
Personal Choice D1-N1 Benefit Summary
Personal Choice D1-N2 Benefit Summary
Personal Choice D2-N1 Benefit Summary
Personal Choice D2-N2 Benefit Summary
Personal Choice D3-N1 Benefit Summary
Personal Choice D3-N2 Benefit Summary
Personal Choice D4-N1 Benefit Summary
Personal Choice D4-N2 Benefit Summary
BlueSaver Solution Health Savings Accounts
Personal Choice HDHP HD1-HC1 Benefit Summary
Personal Choice HDHP HD1-HC2 Benefit Summary
Personal Choice HDHP HD2-HC1 Benefit Summary
Personal Choice HDHP HD2-HC2 Benefit Summary
Personal Choice HDHP HD3-HC1 Benefit Summary
Personal Choice HDHP HD3-HC2 Benefit Summary
Personal Choice HDHP HD4-HC1 Benefit Summary
Personal Choice HDHP HD4-HC2 Benefit Summary
Personal Choice Prescription (Rx) Benefit Summaries
Select Drug Formulary Guide effective 7/1/07
Select Drug Program Key Discussion Points
Select Drug Program Q & A
Select Drug Program Q & A for Injectable Coverage
Biotech/Specialty Injectables List
Procedures That Support Safe Prescribing
Personal Choice Select Rx $5/$10/$25 with oral contraceptives (Option 1)
Personal Choice Select Rx $5/$15/$25 with oral contraceptives (Option 2)
Personal Choice Select Rx $5/$20/$35 with oral contraceptives (Option 3)
Personal Choice Select Rx $10/$30/$50 with oral contraceptives (Option 4)
Personal Choice Select Rx $10/$20/$35 with oral contraceptives (Option 5)
Personal Choice Select Rx $15/$35/$50 with oral contraceptives (Option 6)
Personal Choice Select Rx $20/$40/$60 with oral contraceptives (Option 7)
Personal
Choice Select $0/$25/$50 with oral contraceptives (Option 8)
Personal
Choice Select $5/$30/$50 with oral contraceptives (Option 9)
IBC Vision Benefit Summaries
$35 Vision Bi-Annual Program
$50 Vision Bi-Annual Program
$75 Vision Bi-Annual Program
$100 Vision Bi-Annual Program
$125 Vision Bi-Annual Program
$200 Vision Bi-Annual Program
$250 Vision Bi-Annual Program
The following Personal Choice plans are available for Renewals only:
Personal Choice 5 Benefit Summary
Personal Choice 10 Benefit Summary
Personal Choice 15 Benefit Summary
Personal Choice 20 Benefit Summary
Personal Choice 205 Benefit Summary
Personal Choice 210 Benefit Summary
Personal Choice 215 Benefit Summary
Personal Choice 220 Benefit Summary
Personal Choice 310 Benefit Summary
Personal Choice 320 Benefit Summary
Personal Choice 5-15-70 Benefit Summary
Personal Choice 10-20-70 Benefit Summary
Personal Choice 15-25-70 Benefit Summary
Personal Choice 20-30-70 Benefit Summary
Personal Choice Option I Benefit Summary
Personal Choice Option III Benefit Summary
Personal Choice Option V Benefit Summary
Personal Choice High Deductible 520-80-50 Benefit Summary
Personal Choice High Deductible 1020-80-50 Benefit Summary
Personal Choice High Deductible 2020-80-50 Benefit Summary
Personal Choice High Deductible 2520-80-50 Benefit Summary
The following Personal Choice Rx plans are available for Renewals only:
Personal Choice Standard Rx $5/$10 with oral contraceptives
Personal Choice Standard Rx $5/$20 with oral contraceptives
Personal Choice Standard $6/$10 with oral contraceptives
Personal Choice Standard $10/$15 with oral contraceptives
Personal Choice Standard $10/$20 with oral contraceptives
Personal Choice Standard Rx 50% with oral contraceptives
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