2021 Rx Riders for HMO and POS Plans

Basic Rx Riders for HMO and POS Plans	Download	Size
Basic Rx $10/15 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/15 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/20 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/20 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/20 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/25 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/25 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/25 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/25 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/25 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/30 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/30 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/30 with $250 Pharmacy Deductible	English Spanish	998KB 115KB

Enhanced Rx Riders for HMO and POS Plans	Download	Size
Enhanced Rx $5/10/25 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $5/10/25 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/15/30 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/15/30 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/20/35 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/20/35 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/25/40 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/25/40 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/25/40 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/30/50 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/30/50 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/30/50 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/45 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/45 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/45 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/40/70 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/40/70 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/40/70 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $20/40/60 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $20/40/60 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $20/40/60 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/25/35 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible	English Spanish	998KB 115KB

Premier Rx Riders for HMO and POS Plans	Download	Size
Premier Rx $0/10/25/40 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Premier Rx $0/10/25/40 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Premier Rx $0/10/25/40 with $250 Pharmacy Deductible	English Spanish	998KB 115KB

RX Spectrums Riders for HMO and POS Plans	Download	Size
Rx Spectrum $10/25/40 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Rx Spectrum $15/30/45 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Rx Spectrum $15/30/45 with $150 Pharmacy Deductible	English Spanish	998KB 115KB