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January 2008 Prescription Drug Coverage Options
Select a drug coverage option to accompany the health plan your client is interested in. The information below is effective January 1, 2008 for groups of 51 to 299.
Access+ HMO® and Added Advantage POSSM Plans
Brochure Download Size
2-Tier/Closed Formulary
Access+ HMO Plan with 2-Tier Closed Formulary Prescription Drug Coverage Disclosure English
Spanish
116KB
107KB
Added Advantage POS Plan with 2-Tier Closed Formulary Prescription Drug Coverage Disclosure English
Spanish
118KB
108KB
$5/$10: No brand-name drug deductible English
Spanish
132KB
134KB
$5/$10: $150 brand-name drug deductible English
Spanish
132KB
135KB
$5/$10: $250 brand-name drug deductible

English
Spanish

132KB
135KB
$5/$15: No brand-name drug deductible English
Spanish
132KB
134KB
$5/$15: $150 brand-name drug deductible English
Spanish
132KB
135KB
$5/$15: $250 brand-name drug deductible English
Spanish
132KB
135KB
$10/$15: No brand-name drug deductible English
Spanish
132KB
134KB
$10/$15: $150 brand-name drug deductible English
Spanish
132KB
135KB
$10/$15: $250 brand-name drug deductible

English
Spanish

132KB
135KB
$10/$20: No brand-name drug deductible English
Spanish
132KB
134KB
$10/$20: $150 brand-name drug deductible English
Spanish
132KB
135KB
$10/$20: $250 brand-name drug deductible English
Spanish
132KB
135KB
$10/$25:No brand-name drug deductible English
Spanish
132KB
134KB
$10/$25: $150 brand-name drug deductible English
Spanish
132KB
135KB
$10/$25: $250 brand-name drug deductible English
Spanish
132KB
135KB
$15/$25: No brand-name drug deductible English
Spanish
132KB
134KB
$15/$25: $150 brand-name drug deductible English
Spanish
132KB
135KB
$15/$25: $250 brand-name drug deductible English
Spanish
132KB
135KB
$15/$30:No brand-name drug deductible English
Spanish
132KB
134KB
$15/$30: $150 brand-name drug deductible English
Spanish
132KB
135KB
$15/$30: $250 brand-name drug deductible English
Spanish
132KB
135KB
3-Tier/Incentive Formulary
Access+ HMO Plan with 3-Tier Formulary Prescription Drug Coverage Disclosure English
Spanish
194KB
102KB
Added Advantage POS Plan with 3-Tier Formulary Prescription Drug Coverage Disclosure English
Spanish
199KB
106KB
$5/$10/$25: No brand-name drug deductible English
Spanish
132KB
134KB
$5/$10/$25: $150 brand-name drug deductible English
Spanish
132KB
134KB
$5/$10/$25: $250 brand-name drug deductible English
Spanish
132KB
134KB
$10/$15/$30: No brand-name drug deductible English
Spanish
132KB
134KB
$10/$15/$30: $150 brand-name drug deductible English
Spanish
132KB
134KB
$10/$15/$30: $250 brand-name drug deductible English
Spanish
132KB
134KB
$10/$20/$35: No brand-name drug deductible English
Spanish
132KB
134KB
$10/$20/$35: $150 brand-name drug deductible English
Spanish
132KB
134KB
$10/$20/$35: $250 brand-name drug deductible English
Spanish
132KB
134KB
$10/$25/$40: No brand-name drug deductible English
Spanish
132KB
134KB
$10/$25/$40: $150 brand-name drug deductible English
Spanish
132KB
134KB
$10/$25/$40: $250 brand-name drug deductible English
Spanish
132KB
134KB
$0/$20/$40 - $0/$40/$80 with $0 brand-name drug deductible English
Spanish
34KB
37KB
$0/$20/$40 - $0/$40/$80 with $150 brand-name drug deductible English
Spanish

34KB

37KB

$0/$20/$40 - $0/$40/$80 with $250 brand-name drug deductible English
Spanish

34KB

37KB

$10/$30/$50 - $20/$60/$100 with $0 brand-name drug deductible English
Spanish

34KB

37KB

$10/$30/$50 - $20/$60/$100 with $150 brand-name drug deductible English
Spanish

34KB

37KB

$10/$30/$50 - $20/$60/$100 with $250 brand-name drug deductible English
Spanish

34KB

37KB

$3/$20/$40 - $6/$40/$80 with $0 brand-name drug deductible English
Spanish

34KB

37KB

$3/$20/$40 - $6/$40/$80 with $150 brand-name drug deductible English
Spanish

34KB

37KB

$3/$20/$40 - $6/$40/$80 with $250 brand-name drug deductible English
Spanish

34KB

37KB

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Shield Spectrum PPOSM Plans
Brochure Download Size
3-Tier/Incentive Formulary
Shield Spectrum PPO & PPO Plus Plan Disclosure English
Spanish
106KB
109KB
$5/$10/$25: No brand-name drug deductible English
Spanish
131KB
140KB
$5/$10/$25: $150 brand-name drug deductible English
Spanish
131KB
141KB
$5/$10/$25: $250 brand-name drug deductible English
Spanish
131KB
141KB
$10/$15/$30: No brand-name drug deductible English
Spanish
131KB
140KB
$10/$15/$30: $150 brand-name drug deductible English
Spanish
131KB
141KB
$10/$15/$30: $250 brand-name drug deductible English
Spanish
131KB
141KB
$10/$20/$35: No brand-name drug deductible English
Spanish
131KB
140KB
$10/$20/$35: $150 brand-name drug deductible English
Spanish
131KB
141KB
$10/$20/$35: $250 brand-name drug deductible English
Spanish
131KB
141KB
$10/$25/$40: No brand-name drug deductible English
Spanish
131KB
141KB
$10/$25/$40: $150 brand-name drug deductible English
Spanish
131KB
141KB
$10/$25/$40: $250 brand-name drug deductible English
Spanish
131KB
141KB
$0/$20/$40 - $0/$40/$80: $0 brand-name drug deductible English
Spanish

42KB

39KB

$0/$20/$40 - $0/$40/$80: $150 brand-name drug deductible English
Spanish

42KB

40KB

$10/$30/$50 - $20/$60/$100: $0 brand-name drug deductible English
Spanish

42KB

40KB

$10/$30/$50 - $20/$60/$100: $150 brand-name drug deductible English
Spanish

42KB

39KB

$10/$30/$50 - $20/$60/$100: $250 brand-name drug deductible English
Spanish

42KB

40KB

$3/$20/$40 - $6/$40/$80: $0 brand-name drug deductible English
Spanish

42KB

40KB

$3/$20/$40 - $6/$40/$80: $150 brand-name drug deductible English
Spanish

42KB

39KB

$3/$20/$40 - $6/$40/$80: $250 brand-name drug deductible English
Spanish

42KB

40KB

$0/$20/$40 - $0/$40/$80: $250 brand-name drug deductible English
Spanish

43KB

40KB

Blue Shield Life Plans: Active ChoiceSM, Shield Spectrum PPO Plan 1000-80/60 Premier, PPO 2000 - 70/50, PPO 3000-80/50, PPO 3000 - 80/60 and PPO Foundation plans*

Brochure Download Size
3-Tier/Incentive Formulary
Active Choice Plan Disclosure English
Spanish
251KB
132KB
Shield Spectrum PPO Plan 1000-80/60 Premier, PPO 2000 - 70/50, PPO 3000-80/50, PPO 3000 - 80/60 and PPO Foundation plans Disclosure English
Spanish
220KB
122KB
$5/$10/$25: No brand-name deductible

English
Spanish

137KB
131KB
$5/$10/$25: $150 brand-name deductible English
Spanish
137KB
131KB
$5/$10/$25: $250 brand-name deductible

English
Spanish

137KB
133KB
$5/$10/$25: $500 brand-name deductible English
Spanish
137KB
133KB
$10/$15/$30: No brand-name deductible English
Spanish
137KB
131KB
$10/$15/$30: $150 brand-name deductible English
Spanish
137KB
131KB
$10/$15/$30: $250 brand-name deductible English
Spanish
137KB
132KB
$10/$15/$30: $500 brand-name deductible English
Spanish
137KB
131KB
$10/$20/$35: No brand-name deductible English
Spanish
137KB
133KB
$10/$20/$35: $150 brand-name deductible English
Spanish
137KB
131KB
$10/$20/$35: $250 brand-name deductible English
Spanish
137KB
131KB
$10/$20/$35: $500 brand-name deductible English
Spanish
137KB
131KB
$10/$30/Greater of $45 or 50%: No brand-name deductible English
Spanish
137KB
133KB
$10/$30/Greater of $45 or 50%: $150 brand-name deductible English
Spanish
137KB
131KB
$10/$30/Greater of $45 or 50%: $250 brand-name deductible English
Spanish
137KB
134KB
$10/$30/Greater of $45 or 50%: $500 brand-name deductible English
Spanish
137KB
132KB
$15/$30/$45: No brand-name deductible English
Spanish
137KB
133KB
$15/$30/$45: $150 brand-name deductible English
Spanish
137KB
131KB
$15/$30/$45: $250 brand-name deductible English
Spanish
137KB
131KB
$15/$30/$45: $500 brand-name deductible English
Spanish
137KB
131KB
$0/$20/$40 - $0/$40/$80: $0 brand-name deductible English
Spanish

41KB

40KB

$0/$20/$40 - $0/$40/$80: $150 brand-name deductible English
Spanish

41KB

43KB

$0/$20/$40 - $0/$40/$80: $250 brand-name deductible English
Spanish

41KB

42KB

$0/$20/$40 - $0/$40/$80: $500 brand-name deductible English
Spanish

41KB

43KB

$10/$30/$50 - $20/$60/$100: $0 brand-name deductible English
Spanish

41KB

49KB

$10/$30/$50 - $20/$60/$100: $150 brand-name deductible English
Spanish

41KB

43KB

$10/$30/$50 - $20/$60/$100: $250 brand-name deductible English
Spanish

41KB

42KB

$10/$30/$50 - $20/$60/$100: $500 brand-name deductible English
Spanish

41KB

43KB

$3/$20/$40 - $6/$40/$80: $0 brand-name deductible English
Spanish

41KB

40KB

$3/$20/$40 - $6/$40/$80: $150 brand-name deductible English
Spanish

41KB

43KB

$3/$20/$40 - $6/$40/$80: $250 brand-name deductible English
Spanish

41KB

42KB

$3/$20/$40 - $6/$40/$80: $500 brand-name deductible English
Spanish

41KB

43KB

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* Underwritten by Blue Shield of California Life and Health Insurance Company
TS Owner:Sorry, couldn't look-up page owner email address (from /local/iw-home/local/config/wft/email_map.cfg)?subject=Feedback for/producer/midsizegroups/products/health/jan2008_drugoptions.jsp" title="Email Owner">rwahlb01 Updated:Wed Jan 25 02:58:47 2012 Page:Edit
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