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Benefit modifications brochures

The Benefit Modifications offer a summary of specific benefit changes to your clients' plans in a convenient chart. Keep them up-to-date by downloading and sharing the fliers with your clients upon renewal. Copies will be included along with a complete list of legislative mandates and Blue Shield required changes in each renewal package delivered by your Blue Shield sales representative.

January 2027

2027 Legal Plan Name Size
Access+ HMO® Per Admit 10-250 295 KB
Access+ HMO® Zero Admit 10 294 KB
Access+ HMO® Per Admit 20-500 295 KB
Access+ HMO® Per Admit 20-250 296 KB
Access+ HMO® Per Day 15-500 295 KB
Access+ HMO® Per Day 25-750 296 KB
Access+ HMO® Facility Coinsurance 15-20% 300 KB
Access+ HMO® Facility Coinsurance 25-25% 297 KB
Access+ HMO® Zero Facility Deductible 30-20% 297 KB
Access+ HMO® Facility Coinsurance 40-40% 296 KB
Access+ HMO® Facility Deductible 30-10%/1500 299 KB
Access+ HMO® Zero Admit 20 295 KB
Access+ HMO® Zero Admit 30  296 KB
Access+ HMO® Per Admit 25-750 296 KB
Access+ HMO® Per Admit 40-1000 296 KB
Access+ HMO® Facility Coinsurance 20-20% 295 KB
Access+ HMO® Facility Deductible 15-10%/1500 297 KB
Access+ HMO® Facility Deductible 20-25%/1500 297 KB
Access+ HMO® Facility Deductible 30-30%/2000 297 KB
Access+ HMO® Facility Deductible 40-40%/2000 297 KB
Access+ HMO® Facility Deductible 40-40%/5800 300 KB 
Access+ HMO® Zero Admit 15 295 KB 
Access+ HMO® Facility Coinsurance 30-30% 297 KB
Access+ HMO® Facility Deductible 15-10%/250 297 KB
Access+ HMO® Facility Deductible 15-10%/500 297 KB
Access+ HMO® Facility Deductible 15-10%/750 297 KB
Access+ HMO® Per Day 30-500 298 KB 
Access+ HMO® Per Day 20-500 296 KB
Access+ HMO® Per Day 20-250 296 KB
Local Access+ HMO® Per Admit 20-250 296 KB
Local Access+ HMO® Per Day 20-250 297 KB
Local Access+ HMO® Per Day 20-500 297 KB
Local Access+ HMO® Per Day 30-500 298 KB
Local Access+ HMO® Facility Coinsurance 30-30% 298 KB
Local Access+ HMO® Facility Deductible 15-10%/250 297 KB
Local Access+ HMO® Facility Deductible 15-10%/500 297 KB
Local Access+ HMO® Facility Deductible 15-10%/750 299 KB
Local Access+ HMO® Facility Deductible 30-10%/1500 202 KB
Local Access+ HMO® Per Day 15-500 297 KB
Local Access+ HMO® Per Day 25-750 297 KB
Local Access+ HMO® Zero Admit 15 297 KB
Local Access+ HMO® Zero Facility Deductible 30-20% 298 KB
Local Access+ HMO® Facility Coinsurance 15-20% 297 KB 
Local Access+ HMO® Facility Deductible 40-40%/5800 300 KB
Local Access+ HMO® Facility Coinsurance 40-40% 297 KB
Local Access+ HMO® Per Admit 25-750 296 KB
Local Access+ HMO® Zero Admit 10 295 KB
Local Access+ HMO® Per Admit 10-250 297 KB
Local Access+ HMO® Facility Coinsurance 20-20% 296 KB
Local Access+ HMO® Per Admit 20-500 297 KB
Local Access+ HMO® Facility Coinsurance 25-25% 202 KB
Local Access+ HMO® Zero Admit 20 295 KB
Local Access+ HMO® Zero Admit 30 297 KB
Local Access+ HMO® Per Admit 40-1000 296 KB
Local Access+ HMO® Facility Deductible 40-40%/2000 297 KB
Local Access+ HMO® Facility Deductible 15-10%/1500 297KB
Local Access+ HMO® Facility Deductible 20-25%/1500 298KB
Local Access+ HMO® Facility Deductible 30-30%/2000 298 KB
Trio HMO Per Day 20-250 295 KB
Trio HMO Per Day 20-500 313 KB
Trio HMO Per Day 30-500 297 KB
Trio HMO Zero Admit 30 296 KB
Trio HMO Facility Deductible 15-10%/500 296 KB
Trio HMO Per Admit 20-500 296 KB
Trio HMO Per Admit 25-750 295 KB
Trio HMO Per Admit 40-1000 295 KB
Trio HMO Zero Admit 10 294 KB
Trio HMO Zero Admit 20 294 KB
Trio HMO Facility Coinsurance 20-20% 295 KB
Trio HMO Facility Deductible 40-40%/5800 299 KB
Trio HMO Per Admit 20-250 296 KB
Trio HMO Per Day 15-500 295 KB
Trio HMO Facility Coinsurance 15-20% 296 KB
Trio HMO Facility Deductible 30-10%/1500 298 KB
Trio HMO Zero Facility Deductible 30-20% 297 KB
Trio HMO Per Day 25-750 295 KB
Trio HMO Zero Admit 15 295 KB
Trio HMO Facility Deductible 15-10%/750 296 KB
Trio HMO Facility Coinsurance 30-30% 296 KB 
Trio HMO Facility Coinsurance 25-25% 296 KB
Trio HMO Facility Coinsurance 40-40% 296 KB
Trio HMO Facility Deductible 15-10%/250 314 KB
Trio HMO Per Admit 10-250 295 KB
Trio HMO Facility Deductible 15-10%/1500 296 KB
Trio HMO Facility Deductible 20-25%/1500 296 KB 
Trio HMO Facility Deductible 30-30%/2000 296 KB
Trio HMO Facility Deductible 40-40%/2000 296 KB
Added Advantage POS℠ 300-100/90/70 322 KB
Added Advantage POS℠ 500-100/80/60 323 KB
Full PPO Combined Deductible 25-250 80/60 307 KB
Full PPO Combined Deductible 15-250 90/70 306 KB
Full PPO Combined Deductible 10-250 90/70 306 KB
Shield Spectrum PPO℠ 250-90/70 Standard 329 KB
Full PPO Combined Deductible Value 10-1000 90/70 305 KB
Full PPO Combined Deductible 20-250 80/60 307 KB
Full PPO No Network Deductible 10 100/50 305 KB
Full PPO Savings Embedded Deductible 3500 307 KB
Full PPO Combined Deductible 30-750 80/60  205 KB
Full PPO Combined Deductible Value 25-2500 80/50 306 KB
Full PPO Combined Deductible 20-200 90/70 304 KB
Full PPO Combined Deductible 25-250 90/60 307 KB
Full PPO Combined Deductible 30-500 90/60 309 KB
Full PPO Split Deductible 10-250 90/70 306 KB
Full PPO Split Deductible 15-500 90/60 308 KB 
Full PPO Split Deductible 20-500 80/60 308 KB
Full PPO Split Deductible 25-750 80/60 308 KB
Full PPO Split Deductible 35-1000 80/60 309 KB
Full PPO Combined Deductible Value 15-1500 80/50 305 KB
Full PPO Combined Deductible Value 20-2000 80/50 305 KB
Full PPO Combined Deductible Value 30-3000 80/50 308 KB
Full PPO Combined Deductible Value 40-4000 80/50 308 KB
Full PPO Savings Embedded Deductible 4000 305 KB
Full PPO Combined Deductible 35-500 80/60 309 KB
Full PPO Savings Embedded Deductible 5500 304 KB
Full PPO No Network Deductible 20 100/50 304 KB
Full PPO Split Deductible 30-2000 70/50 306 KB
Full PPO Split Deductible 40-4000 70/50 306 KB
Tandem PPO Combined Deductible 10-250 90/70 306 KB
Tandem PPO Combined Deductible 15-250 90/70 306 KB
Tandem PPO Combined Deductible 20-200 90/70 304 KB
Tandem PPO Combined Deductible 20-250 80/60 307 KB
Tandem PPO Combined Deductible 25-250 80/60 307 KB
Tandem PPO Combined Deductible 25-250 90/60 306 KB
Tandem PPO Combined Deductible Value 10-1000 90/70 305 KB
Tandem PPO No Network Deductible 10 100/50 305 KB
Tandem PPO Split Deductible 10-250 90/70 306 KB
Tandem PPO Split Deductible 25-750 80/60 307 KB
Tandem PPO Split Deductible 20-500 80/60 308 KB
Tandem PPO Split Deductible 35-1000 80/60 309 KB
Full PPO Savings Embedded Deductible 4400 100% 288 KB
Full PPO Combined Deductible Value 50-4500 80/50 295 KB
Full PPO Combined Deductible 10-500 90/70 306 KB
Tandem PPO Split Deductible 30-1500 80/50 308 KB
Tandem PPO Split Deductible 40-3000 70/50 307 KB
Tandem PPO Savings Embedded Deductible 4425 306 KB
Full PPO Combined Deductible 0-400 90/70 305 KB
Full PPO Split Deductible 0-1750 80/60 307 KB
Tandem PPO Combined Deductible 0-400 90/70 305 KB
Tandem PPO Split Deductible 0-1750 80/60 307 KB 
Full EPO Per Admit 10-250 302 KB
Tandem EPO Per Admit 10-250 301 KB
Full PPO Split Deductible 0-500 80/60 308 KB
Tandem PPO Split Deductible 0-500 80/60 307 KB
Full PPO Combined Deductible 0-250 80/60 307 KB
Tandem PPO Combined Deductible 0-250 80/60 307 KB
Full PPO Combined Deductible 0-250 90/70 306 KB
Tandem PPO Combined Deductible 0-250 90/70 306 KB
Active Choice® Plus 1000 80/60 306 KB
Active Choice® Plus 1000 20 80/60 305 KB
Active Choice® Plus 300 80/60 307 KB
Active Choice® Plus 300 20 80/60 307 KB
Active Choice® Classic 850 80/60 307 KB
Active Choice® Classic 600 80/50 307 KB
Active Choice® Classic 850 70/50 1000 Deductible 306 KB
Full EPO Zero Admit 20 300 KB
Full EPO Zero Admit 30 302 KB
Full EPO Facility Coinsurance 20-20% 301 KB
Tandem EPO Zero Admit 20 301 KB
Tandem EPO Zero Admit 30 302 KB
Tandem EPO Facility Coinsurance 20-20% 301 KB
Full EPO 25-1500 80% 303 KB
Tandem EPO 25-1500 80% 303 KB
Full EPO 25-2500 80% 303 KB
Tandem EPO 25-2500 80% 303 KB
Full PPO Savings Embedded Deductible 6350 100% 309 KB
Tandem PPO Savings Embedded Deductible 6350 100% 309KB
Tandem EPO 20-500 80% 303 KB
Tandem EPO 10-250 90% 303 KB
Full EPO 20-500 80% 304 KB
Full EPO 10-250 90% 288 KB
Full PPO Savings Embedded Deductible 5500 with Value Formulary 305 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 with Value Formulary 307 KB
Tandem PPO Savings Embedded Deductible 5500 305 KB
Full PPO Combined Deductible 40-6350 80/50 180 KB
Full PPO Split Deductible 50-6350 70/50 144 KB
Full PPO Split Deductible 50-5000 70/50 304 KB
Active Choice® Classic 600 70/50 2000 Deductible 306 KB
Active Choice® Plus 1000 80/60 1000 Deductible 306 KB
Active Choice® Plus 300 80/60 2000 Deductible 308 KB
Full PPO Savings Embedded Deductible 3500 with Value Formulary 307 KB
Full PPO Savings Embedded Deductible 4000 with Value Formulary 305 KB
Full PPO Savings Embedded Deductible 4400 100% with Value Formulary 279 KB
Full PPO Savings Embedded Deductible 6350 100% with Value Formulary 279 KB
Virtual Blue℠ Full PPO Savings Embedded Deductible 3400 100%  323 KB 
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 with $0 HDHP Preventive Drug Benefit 309 KB 
Virtual Blue℠ Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 323 KB 
Virtual Blue℠ PPO Savings Embedded Deductible 3400 322 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 90/70 309 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3400/4500 with Value Formulary 299 KB
Full PPO Savings Embedded Deductible 3400 100% with Value Formulary 300 KB
Virtual Blue℠ Full PPO Savings Embedded Deductible 3400 100% 323 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3400/3600 311 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 with Value Formulary 307 KB
Virtual Blue℠ PPO Savings Two-Tier Embedded Deductible 1800/3400/3600 326 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3400/4500 299 KB
Tandem PPO Savings Embedded Deductible 3400 306 KB
Virtual Blue℠ PPO Savings Two-Tier Embedded Deductible 2500/3400/5000 324 KB
Tandem PPO Savings Embedded Deductible 3400 100% 307 KB
Full PPO Savings Embedded Deductible 3400/6000 308 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3400/3600 with Value Formulary 311 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 90/60 299 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 100% 307 KB
Virtual Blue℠ PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 307 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3400/4500 with $0 HDHP Preventive Drug Benefit 311 KB
Full PPO Savings Embedded Deductible 3400 100% 180 KB 
Tandem PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 180 KB
Virtual Blue℠ PPO Savings Embedded Deductible 3400 100% 180 KB
Full PPO Savings Embedded Deductible 3400/5200 180 KB
Virtual Blue℠ PPO Split Deductible 50-3000 60/50 324 KB
Virtual Blue℠ PPO Split Deductible 50-1000 70/50 320KB
Virtual Blue℠ PPO Combined Deductible 20-250 80/60 323KB
Virtual Blue℠ EPO 20-2000 70% 317 KB
Virtual Blue℠ EPO 20-1500 80% 317 KB
Virtual Blue℠ EPO 20-1000 80% 319 KB
Virtual Blue℠ EPO 20-750 80% 321 KB
Virtual Blue℠ EPO 20-500 80% 321 KB
Virtual Blue℠ EPO 50-1000 70% 319 KB
Virtual Blue℠ EPO 50-3000 60% 323KB
Virtual Blue℠ EPO 20-250 80% 321 KB
Virtual Blue℠ PPO Savings Embedded Deductible 5500 318 KB
Virtual Blue℠ PPO Combined Deductible 20-250 90/70 322 KB
Virtual Blue℠ PPO Combined Deductible 20-500 80/60 323 KB
Virtual Blue℠ PPO Split Deductible 20-250 90/70 322 KB
Virtual Blue℠ PPO Split Deductible 20-500 80/60 323 KB
Virtual Blue℠ PPO Split Deductible 20-750 80/60 323 KB
Virtual Blue℠ PPO Split Deductible 20-1000 80/60 305 KB
Virtual Blue℠ PPO Split Deductible 20-1500 80/60 323 KB
Virtual Blue℠ PPO Split Deductible 20-2000 70/50 320 KB
Virtual Blue℠ EPO 20-250 90% 321 KB
Virtual Blue℠ EPO Savings Embedded Deductible 5500 321 KB
Virtual Blue℠ EPO Savings Two-Tier Embedded Deductible 2500/3400/5000 324 KB
Virtual Blue℠ EPO Savings Embedded Deductible 3400 323 KB
Virtual Blue℠ EPO Savings Two-Tier Embedded Deductible 1700/3400/3400 323 KB
Virtual Blue℠ EPO Savings Two-Tier Embedded Deductible 1800/3400/3600 326 KB
Virtual Blue℠ EPO Savings Embedded Deductible 3400 100% 323 KB
Virtual Blue℠ EPO Savings Embedded Deductible 4400 100% 321 KB
Virtual Blue℠ PPO Savings Embedded Deductible 4400 100% 321 KB
Virtual Blue℠ Full EPO 20-500 80% 321 KB
Virtual Blue℠ Full PPO Combined Deductible 15-250 90/70 322 KB
Virtual Blue℠ Full PPO No Network Deductible 10 100/50 321 KB
Virtual Blue℠ Full PPO Split Deductible 20-500 80/60 324 KB
Virtual Blue℠ Full PPO Savings Embedded Deductible 5500 321 KB
Full EPO 25-2500 80% with BlueHPN® 304 KB
Full EPO Per Admit 10-250 with BlueHPN® 303 KB
Tandem EPO 25-2500 80% with BlueHPN® 304 KB
Tandem EPO Per Admit 10-250 with BlueHPN® 303 KB
Full PPO Combined Deductible 20-250 90/70 306 KB
Full PPO Combined Deductible 20-500 80/60 307 KB
Full PPO Combined Deductible 25-750 80/60 307 KB
Full EPO Per Admit 15-100 302 KB
Full PPO No Network Deductible 15 90/60 308 KB
Full PPO No Network Deductible 25 80/60 308 KB
Virtual Blue℠ Full PPO Split Deductible 10-250 90/70 322 KB
Virtual Blue℠ Full PPO Split Deductible 35-1000 80/60 325 KB
Virtual Blue℠ Full EPO Savings Embedded Deductible 3400 323 KB

January 2026

2026 Legal Plan Name Size
Access+ HMO® Per Admit 10-250 202 KB
Access+ HMO® Zero Admit 10 202 KB
Access+ HMO® Per Admit 20-500 202 KB
Access+ HMO® Per Admit 20-250 202 KB
Access+ HMO® Per Day 15-500 202 KB
Access+ HMO® Per Day 25-750 202 KB
Access+ HMO® Facility Coinsurance 15-20% 196 KB
Access+ HMO® Facility Coinsurance 25-25% 196 KB
Access+ HMO® Zero Facility Deductible 30-20% 202 KB
Access+ HMO® Facility Coinsurance 40-40% 219 KB
Access+ HMO® Facility Deductible 30-10%/1500 140 KB
Access+ HMO® Zero Admit 20 202 KB
Access+ HMO® Zero Admit 30 202 KB
Access+ HMO® Per Admit 25-750 202 KB
Access+ HMO® Per Admit 40-1000 202 KB
Access+ HMO® Facility Coinsurance 20-20% 196 KB
Access+ HMO® Facility Deductible 15-10%/1500 140 KB
Access+ HMO® Facility Deductible 20-25%/1500 140 KB
Access+ HMO® Facility Deductible 30-30%/2000 140 KB
Access+ HMO® Facility Deductible 40-40%/2000 202 KB
Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Access+ HMO® Zero Admit 15 202 KB
Access+ HMO® Facility Coinsurance 30-30% 219 KB
Access+ HMO® Facility Deductible 15-10%/250 140 KB
Access+ HMO® Facility Deductible 15-10%/500 140 KB
Access+ HMO® Facility Deductible 15-10%/750 140 KB
Access+ HMO® Per Day 30-500 202 KB
Access+ HMO® Per Day 20-500 202 KB
Access+ HMO® Per Day 20-250 202 KB
Local Access+ HMO® Per Admit 20-250 202 KB
Local Access+ HMO® Per Day 20-250 202 KB
Local Access+ HMO® Per Day 20-500 202 KB
Local Access+ HMO® Per Day 30-500 202 KB
Local Access+ HMO® Facility Coinsurance 30-30% 202 KB
Local Access+ HMO® Facility Deductible 15-10%/250 202 KB
Local Access+ HMO® Facility Deductible 15-10%/500 202 KB
Local Access+ HMO® Facility Deductible 15-10%/750 202 KB
Local Access+ HMO® Facility Deductible 30-10%/1500 202 KB
Local Access+ HMO® Per Day 15-500 202 KB
Local Access+ HMO® Per Day 25-750 202 KB
Local Access+ HMO® Zero Admit 15 202 KB
Local Access+ HMO® Zero Facility Deductible 30-20% 202 KB
Local Access+ HMO® Facility Coinsurance 15-20% 202 KB
Local Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Local Access+ HMO® Facility Coinsurance 40-40% 202 KB
Local Access+ HMO® Per Admit 25-750 202 KB
Local Access+ HMO® Zero Admit 10 202 KB
Local Access+ HMO® Per Admit 10-250 202 KB
Local Access+ HMO® Facility Coinsurance 20-20% 202 KB
Local Access+ HMO® Per Admit 20-500 202 KB
Local Access+ HMO® Facility Coinsurance 25-25% 202 KB
Local Access+ HMO® Zero Admit 20 202 KB
Local Access+ HMO® Zero Admit 30 202 KB
Local Access+ HMO® Per Admit 40-1000 202 KB
Local Access+ HMO® Facility Deductible 40-40%/2000 138 KB
Local Access+ HMO® Facility Deductible 15-10%/1500 202 KB
Local Access+ HMO® Facility Deductible 20-25%/1500 202 KB
Local Access+ HMO® Facility Deductible 30-30%/2000 202 KB
Trio HMO Per Day 20-250 180 KB
Trio HMO Per Day 20-500 180 KB
Trio HMO Per Day 30-500 180 KB
Trio HMO Zero Admit 30 180 KB
Trio HMO Facility Deductible 15-10%/500 202 KB
Trio HMO Per Admit 20-500 202 KB
Trio HMO Per Admit 25-750 202 KB
Trio HMO Per Admit 40-1000 202 KB
Trio HMO Zero Admit 10 180 KB
Trio HMO Zero Admit 20 180 KB
Trio HMO Facility Coinsurance 20-20% 202 KB
Trio HMO Facility Deductible 40-40%/5800 143 KB
Trio HMO Per Admit 20-250 202 KB
Trio HMO Per Day 15-500 180 KB
Trio HMO Facility Coinsurance 15-20% 202 KB
Trio HMO Facility Deductible 30-10%/1500 202 KB
Trio HMO Zero Facility Deductible 30-20% 180 KB
Trio HMO Per Day 25-750 180 KB
Trio HMO Zero Admit 15 180 KB
Trio HMO Facility Deductible 15-10%/750 202 KB
Trio HMO Facility Coinsurance 30-30% 202 KB
Trio HMO Facility Coinsurance 25-25% 202 KB
Trio HMO Facility Coinsurance 40-40% 202 KB
Trio HMO Facility Deductible 15-10%/250 202 KB
Trio HMO Per Admit 10-250 202 KB
Trio HMO Facility Deductible 15-10%/1500 202 KB
Trio HMO Facility Deductible 20-25%/1500 202 KB
Trio HMO Facility Deductible 30-30%/2000 202 KB
Trio HMO Facility Deductible 40-40%/2000 202 KB
Added Advantage POS℠ 300-100/90/70 143 KB
Added Advantage POS℠ 500-100/80/60 180 KB
Full PPO Combined Deductible 25-250 80/60 180 KB
Full PPO Combined Deductible 15-250 90/70 180 KB
Full PPO Combined Deductible 10-250 90/70 180 KB
Shield Spectrum PPO℠ 250-90/70 Standard 143 KB
Full PPO Combined Deductible Value 10-1000 90/70 180 KB
Full PPO Combined Deductible 20-250 80/60 180 KB
Full PPO No Network Deductible 10 100/50 180 KB
Full PPO Savings Embedded Deductible 3500 180 KB
Full PPO Savings Embedded Deductible 3300/6000 180 KB
Full PPO Savings Embedded Deductible 3300/5200 180 KB
Full PPO Combined Deductible 30-750 80/60 180 KB
Full PPO Combined Deductible Value 25-2500 80/50 180 KB
Full PPO Combined Deductible 20-200 90/70 180 KB
Full PPO Combined Deductible 25-250 90/60 180 KB
Full PPO Combined Deductible 30-500 90/60 180 KB
Full PPO Split Deductible 10-250 90/70 145KB
Full PPO Split Deductible 15-500 90/60 145KB
Full PPO Split Deductible 20-500 80/60 145KB
Full PPO Split Deductible 25-750 80/60 145KB
Full PPO Split Deductible 35-1000 80/60 979 KB
Full PPO Combined Deductible Value 15-1500 80/50 180 KB
Full PPO Combined Deductible Value 20-2000 80/50 180 KB
Full PPO Combined Deductible Value 30-3000 80/50 180 KB
Full PPO Combined Deductible Value 40-4000 80/50 180 KB
Full PPO Savings Embedded Deductible 4000 180 KB
Full PPO Combined Deductible 35-500 80/60 180 KB
Full PPO Savings Embedded Deductible 5500 180 KB
Full PPO No Network Deductible 20 100/50 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 90/70 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 90/60 180 KB
Full PPO Savings Two-Tier Deductible 1650/3300/3300 with $0 HDHP Preventive Drug Benefit 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3300/3600 180 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 180 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 with $0 HDHP Preventive Drug Benefit 180 KB
Full PPO Split Deductible 30-2000 70/50 145KB
Full PPO Split Deductible 40-4000 70/50 144 KB
Tandem PPO Combined Deductible 10-250 90/70 143 KB
Tandem PPO Combined Deductible 15-250 90/70 143 KB
Tandem PPO Combined Deductible 20-200 90/70 143 KB
Tandem PPO Combined Deductible 20-250 80/60 143 KB
Tandem PPO Combined Deductible 25-250 80/60 143 KB
Tandem PPO Combined Deductible 25-250 90/60 143 KB
Tandem PPO Combined Deductible Value 10-1000 90/70 143 KB
Tandem PPO No Network Deductible 10 100/50 143 KB
Tandem PPO Split Deductible 10-250 90/70 143 KB
Tandem PPO Split Deductible 25-750 80/60 143 KB
Tandem PPO Split Deductible 20-500 80/60 143 KB
Tandem PPO Split Deductible 35-1000 80/60 143 KB
Tandem PPO Savings Embedded Deductible 3300 143 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 100% 180 KB
Full PPO Savings Embedded Deductible 4400 100% 180 KB
Full PPO Combined Deductible Value 50-4500 80/50 143 KB
Full PPO Savings Embedded Deductible 3300 100% 180 KB
Full PPO Combined Deductible 10-500 90/70 180 KB
Tandem PPO Split Deductible 30-1500 80/50 143 KB
Tandem PPO Split Deductible 40-3000 70/50 143 KB
Tandem PPO Savings Embedded Deductible 4425 143 KB
Full PPO Combined Deductible 0-400 90/70 180 KB
Full PPO Split Deductible 0-1750 80/60 143 KB
Tandem PPO Combined Deductible 0-400 90/70 143 KB
Tandem PPO Split Deductible 0-1750 80/60 145KB
Full EPO Per Admit 10-250 180 KB
Tandem EPO Per Admit 10-250 180 KB
Full PPO Split Deductible 0-500 80/60 143 KB
Tandem PPO Split Deductible 0-500 80/60 143 KB
Full PPO Combined Deductible 0-250 80/60 180 KB
Tandem PPO Combined Deductible 0-250 80/60 143 KB
Full PPO Combined Deductible 0-250 90/70 180 KB
Tandem PPO Combined Deductible 0-250 90/70 143 KB
Active Choice® Plus 1000 80/60 180 KB
Active Choice® Plus 1000 20 80/60 180 KB
Active Choice® Plus 300 80/60 180 KB
Active Choice® Plus 300 20 80/60 180 KB
Active Choice® Classic 850 80/60 180 KB
Active Choice® Classic 600 80/50 180 KB
Active Choice® Classic 850 70/50 1000 Deductible 180 KB
Full EPO Zero Admit 20 180 KB
Full EPO Zero Admit 30 180 KB
Full EPO Facility Coinsurance 20-20% 180 KB
Tandem EPO Zero Admit 20 180 KB
Tandem EPO Zero Admit 30 180 KB
Tandem EPO Facility Coinsurance 20-20% 180 KB
Full EPO 25-1500 80% 180 KB
Tandem EPO 25-1500 80% 180 KB
Full EPO 25-2500 80% 180 KB
Tandem EPO 25-2500 80% 180 KB
Full PPO Savings Embedded Deductible 6350 100% 180 KB
Tandem PPO Savings Embedded Deductible 6350 100% 145KB
Tandem EPO 20-500 80% 180 KB
Tandem EPO 10-250 90% 180 KB
Full EPO 20-500 80% 180 KB
Full EPO 10-250 90% 180 KB
Full PPO Savings Embedded Deductible 5500 with Value Formulary 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 with Value Formulary 180 KB
Tandem PPO Savings Embedded Deductible 5500 143 KB
Tandem PPO Savings Embedded Deductible 3300 100% 143 KB
Tandem PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 145KB
Virtual BlueSM PPO Split Deductible 50-3000 60/50 143 KB
Virtual BlueSM PPO Split Deductible 50-1000 70/50 143 KB
Virtual BlueSM PPO Combined Deductible 20-250 80/60 143 KB
Virtual BlueSM EPO 20-2000 70% 180 KB
Virtual BlueSM EPO 20-1500 80% 180 KB
Virtual BlueSM EPO 20-1000 80% 180 KB
Virtual BlueSM EPO 20-750 80% 180 KB
Virtual BlueSM EPO 20-500 80% 180 KB
Virtual BlueSM EPO 50-1000 70% 180 KB
Virtual BlueSM EPO 50-3000 60% 180 KB
Virtual BlueSM EPO 20-250 80% 180 KB
Full PPO Combined Deductible 40-6350 80/50 180 KB
Full PPO Split Deductible 50-6350 70/50 144 KB
Full PPO Split Deductible 50-5000 70/50 144 KB
Active Choice® Classic 600 70/50 2000 Deductible 180 KB
Active Choice® Plus 1000 80/60 1000 Deductible 180 KB
Active Choice® Plus 300 80/60 2000 Deductible 180 KB
Virtual BlueSM PPO Savings Embedded Deductible 5500 143 KB
Virtual BlueSM PPO Savings Two-Tier Embedded Deductible 2500/3300/5000 143 KB
Virtual BlueSM PPO Combined Deductible 20-250 90/70 143 KB
Virtual BlueSM PPO Combined Deductible 20-500 80/60 143 KB
Virtual BlueSM PPO Split Deductible 20-250 90/70 143 KB
Virtual BlueSM PPO Split Deductible 20-500 80/60 143 KB
Virtual BlueSM PPO Split Deductible 20-750 80/60 143 KB
Virtual BlueSM PPO Split Deductible 20-1000 80/60 143 KB
Virtual BlueSM PPO Split Deductible 20-1500 80/60 143 KB
Virtual BlueSM PPO Split Deductible 20-2000 70/50 143 KB
Virtual BlueSM EPO 20-250 90% 180 KB
Virtual BlueSM EPO Savings Embedded Deductible 5500 180 KB
Virtual BlueSM EPO Savings Two-Tier Embedded Deductible 2500/3300/5000 180 KB
Virtual BlueSM EPO Savings Embedded Deductible 3300 180 KB
Virtual BlueSM EPO Savings Two-Tier Embedded Deductible 1650/3300/3300 180 KB
Virtual BlueSM EPO Savings Two-Tier Embedded Deductible 1800/3300/3600 180 KB
Virtual BlueSM EPO Savings Embedded Deductible 3300 100% 180 KB
Virtual BlueSM EPO Savings Embedded Deductible 4400 100% 180 KB
Virtual BlueSM PPO Savings Embedded Deductible 3300 180 KB
Virtual BlueSM PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 180 KB
Virtual BlueSM PPO Savings Two-Tier Embedded Deductible 1800/3300/3600 180 KB
Virtual BlueSM PPO Savings Embedded Deductible 3300 100% 180 KB
Virtual BlueSM PPO Savings Embedded Deductible 4400 100% 180 KB
Virtual BlueSM Full EPO 20-500 80% 180 KB
Virtual BlueSM Full PPO Combined Deductible 15-250 90/70 180 KB
Virtual BlueSM Full PPO No Network Deductible 10 100/50 180 KB
Virtual BlueSM Full PPO Split Deductible 20-500 80/60 180 KB
Virtual BlueSM Full PPO Savings Embedded Deductible 3300 100% 180 KB
Virtual BlueSM Full PPO Savings Embedded Deductible 5500 180 KB
Virtual BlueSM Full PPO Two-Tier Embedded Deductible 1650/3300/3300 180 KB
Full PPO Savings Embedded Deductible 3300 100% with Value Formulary 180 KB
Full PPO Savings Embedded Deductible 3500 with Value Formulary 180 KB
Full PPO Savings Embedded Deductible 4000 with Value Formulary 180 KB
Full PPO Savings Embedded Deductible 4400 100% with Value Formulary 180 KB
Full PPO Savings Embedded Deductible 6350 100% with Value Formulary 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3300/3600 with Value Formulary 180 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 with Value Formulary 180 KB
Virtual Blue℠ Full PPO Savings Embedded Deductible 3400 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 with $0 HDHP Preventive Drug Benefit 180 KB
Virtual Blue℠ Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 180 KB
Virtual Blue℠ PPO Savings Embedded Deductible 3400 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 90/70 180 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3400/4500 with Value Formulary 180 KB
Full PPO Savings Embedded Deductible 3400 100% with Value Formulary 180 KB
Virtual Blue℠ Full PPO Savings Embedded Deductible 3400 100% 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3400/3600 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 with Value Formulary 180 KB
Virtual Blue℠ PPO Savings Two-Tier Embedded Deductible 1800/3400/3600 180 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3400/4500 180 KB
Tandem PPO Savings Embedded Deductible 3400 180 KB
Virtual Blue℠ PPO Savings Two-Tier Embedded Deductible 2500/3400/5000 180 KB
Tandem PPO Savings Embedded Deductible 3400 100% 180 KB
Full PPO Savings Embedded Deductible 3400/6000 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3400/3600 with Value Formulary 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 90/60 180 KB
Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 100% 180 KB
Virtual Blue℠ PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 180 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3400/4500 with $0 HDHP Preventive Drug Benefit 180 KB
Full PPO Savings Embedded Deductible 3400 100% 180 KB
Tandem PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 180 KB
Virtual Blue℠ PPO Savings Embedded Deductible 3400 100% 180 KB
Full PPO Savings Embedded Deductible 3400/5200 180 KB

January 2025

2025 Legal Plan Name Size
Access+ HMO® Facility Coinsurance 15-20% 125 KB
Access+ HMO® Facility Coinsurance 20-20% 125 KB
Access+ HMO® Facility Coinsurance 25-25% 125 KB
Access+ HMO® Facility Coinsurance 30-30% 135 KB
Access+ HMO® Facility Coinsurance 40-40% 135 KB
Access+ HMO® Facility Deductible 15-10%/1500 140 KB
Access+ HMO® Facility Deductible 15-10%/250 140 KB
Access+ HMO® Facility Deductible 15-10%/500 140 KB
Access+ HMO® Facility Deductible 15-10%/750 140 KB
Access+ HMO® Facility Deductible 20-25%/1500 140 KB
Access+ HMO® Facility Deductible 30-10%/1500 140 KB
Access+ HMO® Facility Deductible 30-30%/2000 140 KB
Access+ HMO® Facility Deductible 40-40%/2000 145 KB
Access+ HMO® Per Admit 10-250 145 KB
Access+ HMO® Per Admit 20-250 145 KB
Access+ HMO® Per Admit 20-500 145 KB
Access+ HMO® Per Admit 25-750 145 KB
Access+ HMO® Per Admit 40-1000 145 KB
Access+ HMO® Per Day 15-500 145 KB
Access+ HMO® Per Day 20-250 145 KB
Access+ HMO® Per Day 20-500 145 KB
Access+ HMO® Per Day 25-750 145 KB
Access+ HMO® Per Day 30-500 145 KB
Access+ HMO® Zero Admit 10 145 KB
Access+ HMO® Zero Admit 15 145 KB
Access+ HMO® Zero Admit 20 145 KB
Access+ HMO® Zero Admit 30 145 KB
Access+ HMO® Zero Facility Deductible 30-20% 145 KB
Local Access+ HMO® Facility Coinsurance 15-20% 145 KB
Local Access+ HMO® Facility Coinsurance 20-20% 145 KB
Local Access+ HMO® Facility Coinsurance 25-25% 145 KB
Local Access+ HMO® Facility Coinsurance 40-40% 145 KB
Local Access+ HMO® Facility Deductible 15-10%/1500 145 KB
Local Access+ HMO® Facility Deductible 20-25%/1500 145 KB
Local Access+ HMO® Facility Deductible 30-30%/2000 145 KB
Local Access+ HMO® Facility Deductible 40-40%/2000 138 KB
Local Access+ HMO® Per Admit 10-250 145 KB
Local Access+ HMO® Per Admit 20-250 145 KB
Local Access+ HMO® Per Admit 20-500 145 KB
Local Access+ HMO® Per Admit 25-750 145 KB
Local Access+ HMO® Per Admit 40-1000 145 KB
Local Access+ HMO® Per Day 20-250 145 KB
Local Access+ HMO® Per Day 20-500 145 KB
Local Access+ HMO® Per Day 30-500 145 KB
Local Access+ HMO® Zero Admit 10 145 KB
Local Access+ HMO® Zero Admit 20 145 KB
Local Access+ HMO® Zero Admit 30 145 KB
Trio HMO Facility Coinsurance 15-20% 145 KB
Trio HMO Facility Coinsurance 20-20% 145 KB
Trio HMO Facility Coinsurance 25-25% 145 KB
Trio HMO Facility Coinsurance 30-30% 145 KB
Trio HMO Facility Coinsurance 40-40% 145 KB
Trio HMO Facility Deductible 15-10%/1500 145 KB
Trio HMO Facility Deductible 15-10%/250 145 KB
Trio HMO Facility Deductible 15-10%/500 145 KB
Trio HMO Facility Deductible 15-10%/750 145 KB
Trio HMO Facility Deductible 20-25%/1500 145 KB
Trio HMO Facility Deductible 30-10%/1500 145 KB
Trio HMO Facility Deductible 30-30%/2000 145 KB
Trio HMO Facility Deductible 40-40%/2000 145 KB
Trio HMO Per Admit 10-250 145 KB
Trio HMO Per Admit 20-250 145 KB
Trio HMO Per Admit 20-500 145 KB
Trio HMO Per Admit 25-750 145 KB
Trio HMO Per Admit 40-1000 145 KB
Trio HMO Per Day 15-500 142 KB
Trio HMO Per Day 20-250 142 KB
Trio HMO Per Day 20-500 142 KB
Trio HMO Per Day 25-750 142 KB
Trio HMO Per Day 30-500 142 KB
Trio HMO Zero Admit 10 142 KB
Trio HMO Zero Admit 15 142 KB
Trio HMO Zero Admit 20 142 KB
Trio HMO Zero Admit 30 142 KB
Trio HMO Zero Facility Deductible 30-20% 142 KB
Full EPO 10-250 90% 142 KB
Full EPO 20-500 80% 142 KB
Full EPO 25-1500 80% 142 KB
Full EPO 25-2500 80% 142 KB
Full EPO Facility Coinsurance 20-20% 142 KB
Full EPO Per Admit 10-250 142 KB
Full EPO Zero Admit 20 142 KB
Full EPO Zero Admit 30 142 KB
Tandem EPO 10-250 90% 142 KB
Tandem EPO 20-500 80% 142 KB
Tandem EPO 25-1500 80% 142 KB
Tandem EPO 25-2500 80% 142 KB
Tandem EPO Facility Coinsurance 20-20% 142 KB
Tandem EPO Per Admit 10-250 142 KB
Tandem EPO Zero Admit 20 142 KB
Tandem EPO Zero Admit 30 142 KB
Virtual BlueSM EPO 20-1000 80% 142 KB
Virtual BlueSM EPO 20-1500 80% 142 KB
Virtual BlueSM EPO 20-2000 70% 142 KB
Virtual BlueSM EPO 20-250 80% 142 KB
Virtual BlueSM EPO 20-250 90% 142 KB
Virtual BlueSM EPO 20-500 80% 142 KB
Virtual BlueSM EPO 20-750 80% 142 KB
Virtual BlueSM EPO 50-1000 70% 142 KB
Virtual BlueSM EPO 50-3000 60% 142 KB
Active Choice® Classic 600 70/50 2000 Deductible 142 KB
Active Choice® Classic 600 80/50 142 KB
Active Choice® Classic 850 70/50 1000 Deductible 142 KB
Active Choice® Classic 850 80/60 142 KB
Active Choice® Plus 1000 20 80/60 142 KB
Active Choice® Plus 1000 80/60 142 KB
Active Choice® Plus 1000 80/60 1000 Deductible 142 KB
Active Choice® Plus 300 20 80/60 142 KB
Active Choice® Plus 300 80/60 142 KB
Active Choice® Plus 300 80/60 2000 Deductible 142 KB
Added Advantage POS℠ 500-100/80/60 142 KB
Full PPO Combined Deductible 0-250 80/60 142 KB
Full PPO Combined Deductible 0-250 90/70 142 KB
Full PPO Combined Deductible 0-400 90/70 142 KB
Full PPO Combined Deductible 10-250 90/70 142 KB
Full PPO Combined Deductible 10-500 90/70 142 KB
Full PPO Combined Deductible 15-250 90/70 142 KB
Full PPO Combined Deductible 20-200 90/70 142 KB
Full PPO Combined Deductible 20-250 80/60 142 KB
Full PPO Combined Deductible 25-250 80/60 142 KB
Full PPO Combined Deductible 25-250 90/60 142 KB
Full PPO Combined Deductible 30-500 90/60 142 KB
Full PPO Combined Deductible 30-750 80/60 142 KB
Full PPO Combined Deductible 35-500 80/60 142 KB
Full PPO Combined Deductible 40-6350 80/50 142 KB
Full PPO Combined Deductible Value 10-1000 90/70 142 KB
Full PPO Combined Deductible Value 15-1500 80/50 142 KB
Full PPO Combined Deductible Value 20-2000 80/50 142 KB
Full PPO Combined Deductible Value 25-2500 80/50 142 KB
Full PPO Combined Deductible Value 30-3000 80/50 142 KB
Full PPO Combined Deductible Value 40-4000 80/50 142 KB
Full PPO No Network Deductible 10 100/50 142 KB
Full PPO No Network Deductible 20 100/50 142 KB
Full PPO Savings Embedded Deductible 3300 100% 142 KB
Full PPO Savings Embedded Deductible 3300/5200 142 KB
Full PPO Savings Embedded Deductible 3300/6000 142 KB
Full PPO Savings Embedded Deductible 3500 142 KB
Full PPO Savings Embedded Deductible 4000 142 KB
Full PPO Savings Embedded Deductible 4400 100% 142 KB
Full PPO Savings Embedded Deductible 5500 142 KB
Full PPO Savings Embedded Deductible 5500 with Value Formulary 142 KB
Full PPO Savings Embedded Deductible 6350 100% 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 100% 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 90/60 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 90/70 142 KB
Full PPO Savings Two-Tier Deductible 1650/3300/3300 with $0 HDHP Preventive Drug Benefit 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 with Value Formulary 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3300/3600 142 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 142 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 with $0 HDHP Preventive Drug Benefit 142 KB
Full PPO Split Deductible 0-1750 80/60 143 KB
Full PPO Split Deductible 0-500 80/60 143 KB
Full PPO Split Deductible 10-250 90/70 145KB
Full PPO Split Deductible 15-500 90/60 145KB
Full PPO Split Deductible 20-500 80/60 145KB
Full PPO Split Deductible 25-750 80/60 145KB
Full PPO Split Deductible 30-2000 70/50 145KB
Full PPO Split Deductible 35-1000 80/60 979 KB
Full PPO Split Deductible 40-4000 70/50 144 KB
Full PPO Split Deductible 50-5000 70/50 144 KB
Full PPO Split Deductible 50-6350 70/50 144 KB
Tandem PPO Combined Deductible 0-250 80/60 143 KB
Tandem PPO Combined Deductible 0-250 90/70 143 KB
Tandem PPO Combined Deductible 0-400 90/70 143 KB
Tandem PPO Combined Deductible 10-250 90/70 143 KB
Tandem PPO Combined Deductible 15-250 90/70 143 KB
Tandem PPO Combined Deductible 20-250 80/60 143 KB
Tandem PPO No Network Deductible 10 100/50 143 KB
Tandem PPO Savings Embedded Deductible 3300 143 KB
Tandem PPO Savings Embedded Deductible 3300 100% 143 KB
Tandem PPO Savings Embedded Deductible 4425 143 KB
Tandem PPO Savings Embedded Deductible 5500 143 KB
Tandem PPO Savings Embedded Deductible 6350 100% 145KB
Tandem PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 145KB
Tandem PPO Split Deductible 0-1750 80/60 145KB
Tandem PPO Split Deductible 0-500 80/60 143 KB
Tandem PPO Split Deductible 10-250 90/70 143 KB
Tandem PPO Split Deductible 20-500 80/60 143 KB
Tandem PPO Split Deductible 25-750 80/60 143 KB
Tandem PPO Split Deductible 35-1000 80/60 143 KB
Virtual Blue PPO Combined Deductible 20-250 80/60 143 KB
Virtual Blue PPO Combined Deductible 20-250 90/70 143 KB
Virtual Blue PPO Combined Deductible 20-500 80/60 143 KB
Virtual Blue PPO Savings Embedded Deductible 5500 143 KB
Virtual Blue PPO Savings Two-Tier Embedded Deductible 2500/3300/5000 143 KB
Virtual Blue PPO Split Deductible 20-1000 80/60 143 KB
Virtual Blue PPO Split Deductible 20-1500 80/60 143 KB
Virtual Blue PPO Split Deductible 20-2000 70/50 143 KB
Virtual Blue PPO Split Deductible 20-250 90/70 143 KB
Virtual Blue PPO Split Deductible 20-500 80/60 143 KB
Virtual Blue PPO Split Deductible 20-750 80/60 143 KB
Virtual Blue PPO Split Deductible 50-1000 70/50 143 KB
Virtual Blue PPO Split Deductible 50-3000 60/50 143 KB

 

Not Marketed HMO Ben Mods Size
Access+ HMO® SaveNet Facility Deductible 15-10%/1500 143 KB
Access+ HMO® SaveNet Facility Deductible 20-25%/1500 143 KB
Access+ HMO® SaveNet Facility Deductible 30-30%/2000 143 KB
Access+ HMO® SaveNet Facility Deductible 40-40%/2000 143 KB
Access+ HMO® SaveNet Per Admit 20-500 143 KB
Access+ HMO® SaveNet Per Admit 25-750 143 KB
Access+ HMO® SaveNet Per Admit 40-1000 143 KB
Access+ HMO® SaveNet Zero Admit 10 143 KB
Access+ HMO® SaveNet Zero Admit 20 143 KB
Access+ HMO® SaveNet Zero Admit 30 143 KB
Access+ HMO® SaveNet Facility Coinsurance 40-40% 143 KB
Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Access+ HMO® SaveNet Per Admit 10-250 143 KB
Access+ HMO® SaveNet Facility Coinsurance 15-20% 143 KB
Local Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Access+ HMO® SaveNet Facility Deductible 40-40%/5800 143 KB
Trio HMO Facility Deductible 40-40%/5800 143 KB
Access+ HMO® SaveNet Facility Coinsurance 25-25% 143 KB
Access+ HMO® SaveNet Facility Coinsurance 20-20% 143 KB

 

Not Marketed PPO Ben Mods Size
Shield Spectrum PPO℠ 250-90/70 Standard 143 KB
Tandem PPO Combined Deductible 20-200 90/70 143 KB
Tandem PPO Combined Deductible 25-250 80/60 143 KB
Tandem PPO Combined Deductible 25-250 90/60 143 KB
Tandem PPO Combined Deductible Value 10-1000 90/70 143 KB
Full PPO Combined Deductible Value 50-4500 80/50 143 KB
Tandem PPO Split Deductible 30-1500 80/50 143 KB
Tandem PPO Split Deductible 40-3000 70/50 143 KB

 

Not Marketed POS Ben Mods Size
Added Advantage POS℠ 300-100/90/70 143 KB

January 2024

2024 Legal Plan Name Size
Access+ HMO® Facility Coinsurance 15-20% 125 KB
Access+ HMO® Facility Coinsurance 20-20% 125 KB
Access+ HMO® Facility Coinsurance 25-25% 125 KB
Access+ HMO® Facility Coinsurance 30-30% 135 KB
Access+ HMO® Facility Coinsurance 40-40% 135 KB
Access+ HMO® Facility Deductible 15-10%/1500 140 KB
Access+ HMO® Facility Deductible 15-10%/250 140 KB
Access+ HMO® Facility Deductible 15-10%/500 140 KB
Access+ HMO® Facility Deductible 15-10%/750 140 KB
Access+ HMO® Facility Deductible 20-25%/1500 140 KB
Access+ HMO® Facility Deductible 30-10%/1500 140 KB
Access+ HMO® Facility Deductible 30-30%/2000 140 KB
Access+ HMO® Facility Deductible 40-40%/2000 145 KB
Access+ HMO® Per Admit 10-250 145 KB
Access+ HMO® Per Admit 20-250 145 KB
Access+ HMO® Per Admit 20-500 145 KB
Access+ HMO® Per Admit 25-750 145 KB
Access+ HMO® Per Admit 40-1000 145 KB
Access+ HMO® Per Day 15-500 145 KB
Access+ HMO® Per Day 20-250 145 KB
Access+ HMO® Per Day 20-500 145 KB
Access+ HMO® Per Day 25-750 145 KB
Access+ HMO® Per Day 30-500 145 KB
Access+ HMO® Zero Admit 10 145 KB
Access+ HMO® Zero Admit 15 145 KB
Access+ HMO® Zero Admit 20 145 KB
Access+ HMO® Zero Admit 30 145 KB
Access+ HMO® Zero Facility Deductible 30-20% 145 KB
Local Access+ HMO® Facility Coinsurance 15-20% 145 KB
Local Access+ HMO® Facility Coinsurance 40-40% 138 KB
Local Access+ HMO® Per Admit 25-750 145 KB
Local Access+ HMO® Zero Admit 10 145 KB
Local Access+ HMO® Zero Admit 20 145 KB
Local Access+ HMO® Zero Admit 30 145 KB
Local Access+ HMO® Per Admit 10-250 140 KB
Local Access+ HMO® Per Admit 20-250 140 KB
Local Access+ HMO® Per Admit 20-500 140 KB
Local Access+ HMO® Per Admit 40-1000 140 KB
Local Access+ HMO® Per Day 20-250 140 KB
Local Access+ HMO® Per Day 20-500 140 KB
Local Access+ HMO® Per Day 30-500 140 KB
Local Access+ HMO® Facility Coinsurance 20-20% 145 KB
Local Access+ HMO® Facility Coinsurance 25-25% 140 KB
Trio HMO Facility Coinsurance 15-20% 145 KB
Trio HMO Facility Coinsurance 20-20% 145 KB
Trio HMO Facility Coinsurance 25-25% 145 KB
Trio HMO Facility Coinsurance 30-30% 145 KB
Trio HMO Facility Coinsurance 40-40% 145 KB
Trio HMO Facility Deductible 15-10%/1500 145 KB
Trio HMO Facility Deductible 15-10%/250 145 KB
Trio HMO Facility Deductible 15-10%/500 145 KB
Trio HMO Facility Deductible 15-10%/750 145 KB
Trio HMO Facility Deductible 20-25%/1500 145 KB
Trio HMO Facility Deductible 30-10%/1500 145 KB
Trio HMO Facility Deductible 30-30%/2000 145 KB
Trio HMO Facility Deductible 40-40%/2000 145 KB
Trio HMO Per Admit 10-250 145 KB
Trio HMO Per Admit 20-250 145 KB
Trio HMO Per Admit 20-500 145 KB
Trio HMO Per Admit 25-750 145 KB
Trio HMO Per Admit 40-1000 145 KB
Trio HMO Per Day 15-500 142 KB
Trio HMO Per Day 20-250 142 KB
Trio HMO Per Day 20-500 142 KB
Trio HMO Per Day 25-750 142 KB
Trio HMO Per Day 30-500 142 KB
Trio HMO Zero Admit 10 142 KB
Trio HMO Zero Admit 15 142 KB
Trio HMO Zero Admit 20 142 KB
Trio HMO Zero Admit 30 142 KB
Trio HMO Zero Facility Deductible 30-20% 142 KB
Full EPO 25-1500 80% 142 KB
Full EPO 25-2500 80% 142 KB
Full EPO Facility Coinsurance 20-20% 142 KB
Full EPO Per Admit 10-250 142 KB
Full EPO Zero Admit 20 142 KB
Full EPO Zero Admit 30 142 KB
Tandem EPO 25-1500 80% 142 KB
Tandem EPO 25-2500 80% 142 KB
Tandem EPO Facility Coinsurance 20-20% 142 KB
Tandem EPO Per Admit 10-250 142 KB
Tandem EPO Zero Admit 20 142 KB
Tandem EPO Zero Admit 30 142 KB
Tandem EPO 20-500 80% 142 KB
Tandem EPO 10-250 90% 142 KB
Full EPO 20-500 80% 142 KB
Full EPO 10-250 90% 142 KB
Added Advantage POS℠ 500-100/80/60 142 KB
Active Choice® Classic 600 80/50 142 KB
Active Choice® Classic 850 70/50 1000 Deductible 142 KB
Active Choice® Classic 850 80/60 142 KB
Active Choice® Plus 1000 20 80/60 142 KB
Active Choice® Plus 1000 80/60 142 KB
Active Choice® Plus 300 20 80/60 142 KB
Active Choice® Plus 300 80/60 142 KB
Full PPO Combined Deductible 0-250 80/60 142 KB
Full PPO Combined Deductible 0-250 90/70 142 KB
Full PPO Combined Deductible 0-400 90/70 142 KB
Full PPO Combined Deductible 10-250 90/70 142 KB
Full PPO Combined Deductible 10-500 90/70 142 KB
Full PPO Combined Deductible 15-250 90/70 142 KB
Full PPO Combined Deductible 20-200 90/70 142 KB
Full PPO Combined Deductible 20-250 80/60 142 KB
Full PPO Combined Deductible 25-250 80/60 142 KB
Full PPO Combined Deductible 25-250 90/60 142 KB
Full PPO Combined Deductible 30-500 90/60 142 KB
Full PPO Combined Deductible 30-750 80/60 142 KB
Full PPO Combined Deductible 35-500 80/60 142 KB
Full PPO Combined Deductible Value 10-1000 90/70 142 KB
Full PPO Combined Deductible Value 15-1500 80/50 142 KB
Full PPO Combined Deductible Value 20-2000 80/50 142 KB
Full PPO Combined Deductible Value 25-2500 80/50 142 KB
Full PPO Combined Deductible Value 30-3000 80/50 142 KB
Full PPO Combined Deductible Value 40-4000 80/50 142 KB
Full PPO No Network Deductible 10 100/50 142 KB
Full PPO No Network Deductible 20 100/50 142 KB
Full PPO Savings Embedded Deductible 3200/5200 142 KB
Full PPO Savings Embedded Deductible 3200/6000 142 KB
Full PPO Savings Embedded Deductible 3200 100% 142 KB
Full PPO Savings Embedded Deductible 3500 142 KB
Full PPO Savings Embedded Deductible 4000 142 KB
Full PPO Savings Embedded Deductible 4400 100% 142 KB
Full PPO Savings Embedded Deductible 5500 142 KB
Full PPO Savings Embedded Deductible 6350 100% 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 90/70 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 90/60 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 100% 142 KB
Full PPO Savings Two-Tier Deductible 1600/3200/3200 with $0 HDHP Preventive Drug Benefit 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3200/3600 142 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3200/4500 142 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3200/4500 with $0 HDHP Preventive Drug Benefit 142 KB
Full PPO Savings Embedded Deductible 5500 with Value Formulary 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 with Value Formulary 143 KB
Tandem PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 90/60 143 KB
Full PPO Split Deductible 0-1750 80/60 143 KB
Full PPO Split Deductible 0-500 80/60 143 KB
Full PPO Split Deductible 10-250 90/70 145KB
Full PPO Split Deductible 15-500 90/60 145KB
Full PPO Split Deductible 20-500 80/60 145KB
Full PPO Split Deductible 25-750 80/60 145KB
Full PPO Split Deductible 30-2000 70/50 145KB
Full PPO Split Deductible 35-1000 80/60 979 KB
Full PPO Split Deductible 40-4000 70/50 144 KB
Tandem PPO Combined Deductible 0-250 80/60 143 KB
Tandem PPO Combined Deductible 0-250 90/70 143 KB
Tandem PPO Combined Deductible 0-400 90/70 143 KB
Tandem PPO Combined Deductible 10-250 90/70 143 KB
Tandem PPO Combined Deductible 15-250 90/70 143 KB
Tandem PPO Combined Deductible 20-250 80/60 143 KB
Tandem PPO No Network Deductible 10 100/50 143 KB
Tandem PPO Savings Embedded Deductible 3200 143 KB
Tandem PPO Savings Embedded Deductible 5500 143 KB
Tandem PPO Savings Embedded Deductible 3200 100% 143 KB
Tandem PPO Savings Embedded Deductible 4425 143 KB
Tandem PPO Savings Embedded Deductible 6350 100% 145KB
Tandem PPO Split Deductible 0-1750 80/60 145KB
Tandem PPO Split Deductible 0-500 80/60 143 KB
Tandem PPO Split Deductible 10-250 90/70 143 KB
Tandem PPO Split Deductible 20-500 80/60 143 KB
Tandem PPO Split Deductible 25-750 80/60 143 KB
Tandem PPO Split Deductible 35-1000 80/60 143 KB
Virtual Blue PPO Split Deductible 50-3000 60/50 143 KB
Virtual Blue PPO Split Deductible 50-1000 70/50 143 KB
Virtual Blue PPO Combined Deductible 20-250 80/60 143 KB

 

Not Marketed HMO Ben Mods Size
Access+ HMO® SaveNet Per Admit 10-250 143 KB
Access+ HMO® SaveNet Facility Coinsurance 15-20% 143 KB
Local Access+ HMO® Facility Deductible 15-10%/1500 143 KB
Local Access+ HMO® Facility Deductible 20-25%/1500 143 KB
Access+ HMO® SaveNet Zero Admit 10 143 KB
Access+ HMO® SaveNet Zero Admit 20 143 KB
Access+ HMO® SaveNet Zero Admit 30 143 KB
Access+ HMO® SaveNet Per Admit 20-500 143 KB
Access+ HMO® SaveNet Per Admit 25-750 143 KB
Access+ HMO® SaveNet Per Admit 40-1000 143 KB
Access+ HMO® SaveNet Facility Coinsurance 20-20% 143 KB
Access+ HMO® SaveNet Facility Coinsurance 25-25% 143 KB
Access+ HMO® SaveNet Facility Coinsurance 40-40% 143 KB
Access+ HMO® SaveNet Facility Deductible 15-10%/1500 143 KB
Access+ HMO® SaveNet Facility Deductible 20-25%/1500 143 KB
Access+ HMO® SaveNet Facility Deductible 30-30%/2000 143 KB
Access+ HMO® SaveNet Facility Deductible 40-40%/2000 143 KB
Local Access+ HMO® Facility Deductible 30-30%/2000 143 KB
Local Access+ HMO® Facility Deductible 40-40%/2000 143 KB
Trio HMO Facility Deductible 40-40%/5800 143 KB
Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Local Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Access+ HMO® SaveNet Facility Deductible 40-40%/5800 143 KB

 

Not Marketed PPO Ben Mods Size
Shield Spectrum PPO℠ 250-90/70 Standard 143 KB
Tandem PPO Combined Deductible 20-200 90/70 143 KB
Tandem PPO Combined Deductible 25-250 80/60 143 KB
Tandem PPO Combined Deductible 25-250 90/60 143 KB
Tandem PPO Combined Deductible Value 10-1000 90/70 143 KB
Full PPO Combined Deductible Value 50-4500 80/50 143 KB
Tandem PPO Split Deductible 30-1500 80/50 143 KB
Tandem PPO Split Deductible 40-3000 70/50 143 KB

 

Not Marketed POS Ben Mods Size
Added Advantage POS℠ 300-100/90/70 143 KB