2019 Rx Riders for HMO and POS Plans

2019 Rx Riders for HMO and POS Plans

Basic Rx Riders for HMO and POS Plans Download Size
Basic Rx $10/15 - $20/30 with $0 Pharmacy Deductible English 
Spanish 
26KB
26KB
Basic Rx $10/15 - $20/30 with $150 Pharmacy Deductible English 
Spanish
26KB
26KB
Basic Rx $10/15 - $20/30 with $250 Pharmacy Deductible English 
Spanish
26KB
26KB
Basic Rx $10/20 - $20/40 with $0 Pharmacy Deductible English 
Spanish
26KB
26KB
Basic Rx $10/20 - $20/40 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $10/20 - $20/40 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $10/25 - $20/50 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $10/25 - $20/50 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $10/25 - $20/50 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $15/25 - $30/50 with $0 Pharmacy Deductible English 
Spanish
26KB
26KB
Basic Rx $15/25 - $30/50 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $15/25 - $30/50 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $15/30 - $30/60 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $15/30 - $30/60 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Basic Rx $15/30 - $30/60 with $250 Pharmacy Deductible English
Spanish
26KB
26KB

 

Enhanced Rx Riders for HMO and POS Plans Download Size
Enhanced Rx $5/10/25 - $10/20/50 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $5/10/25 - $10/20/50 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $5/10/25 - $10/20/50 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/15/30 - $20/30/60 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/15/30 - $20/30/60 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/15/30 - $20/30/60 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/20/35 - $20/40/70 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/20/35 - $20/40/70 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/20/35 - $20/40/70 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/25/40 - $20/50/80 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/25/40 - $20/50/80 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/25/40 - $20/50/80 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/30/50 - $20/60/100 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/30/50 - $20/60/100 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $10/30/50 - $20/60/100 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $15/30/45 - $30/60/90 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $15/30/45 - $30/60/90 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $15/30/45 - $30/60/90 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $15/30/50%  $100 max- $30/60/50% $90 min $200 max with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $15/30/50% $100 max - $30/60/50% $90 min $200 max with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx $15/30/50%  $100 max - $30/60/50% $90 min $200 max with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx - Value Formulary $10/25/40 - $20/50/80 with $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx - Value Formulary $10/25/40 - $20/50/80 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx - Value Formulary $10/25/40 - $20/50/80 with $250 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx - Value Formulary $15/30/45 - $30/60/90 with  $0 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx - Value Formulary $15/30/45 - $30/60/90 with $150 Pharmacy Deductible English
Spanish
26KB
26KB
Enhanced Rx - Value Formulary $15/30/45 - $30/60/90 with $250 Pharmacy Deductible English
Spanish
26KB
26KB

 

Premier Rx Riders for HMO and POS Plans Download Size
Premier Rx $0/10/25/40 - $0/20/50/80 with $0 Pharmacy Deductible English 
Spanish
26KB
26KB
Premier Rx $0/10/25/40 - $0/20/50/80 with $150 Pharmacy Deductible English 
Spanish
26KB
26KB
Premier Rx $0/10/25/40 - $0/20/50/80 with $250 Pharmacy Deductible English 
Spanish
26KB
26KB

 

RX Spectrums Riders for HMO and POS Plans Download Size
Rx Spectrum $10/25/40 - $20/50/80 with $0 Pharmacy Deductible English 
Spanish
26KB
26KB
Rx Spectrum $15/30/45 - $30/60/90 with $0 Pharmacy Deductible English 
Spanish
26KB
26KB
Rx Spectrum $0/10/25/40 - $0/20/50/80 with $0 Pharmacy Deductible English 
Spanish
26KB
26KB
Rx Spectrum $15/30/45 - $30/60/90 with $150 Pharmacy Deductible English 
Spanish
26KB
26KB
Rx Spectrum $15/30/50% $100 max - $30/60/50% $200 max with  
$250 Pharmacy Deductible
English 
Spanish
26KB
26KB

 

Contact Us

  • Producer Services (800) 559-5905

    Employer Services (800) 325-5166

  • Blue Shield of California

    PO Box 272540

    Chico, CA 95927-2540

  • Quick Links

    About Blue Shield

    Contact Us

    News

    Careers

  •  

    Send Feedback

    Terms of Use

    Privacy

    Sitemap

  • Get Social

    • TRUSTe

© California Physicians’ Service DBA Blue Shield of California 1999-2022. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association.

Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.