All PDFs
Flex PC Copay Options
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
Flex Personal
Choice C4-F3-O1
Flex Personal
Choice C4-F3-O2
Flex Personal
Choice C4-F4-O1
Flex Personal
Choice C4-F4-O2
Flex Personal
Choice C4-F5-O2
Flex Deductible PC Options
Personal Choice D1-N1
Personal Choice D1-N2
Personal Choice D2-N1
Personal Choice D2-N2
Personal Choice D3-N1
Personal Choice D3-N2
Personal Choice D4-N1
Personal Choice D4-N2
BlueSaver Solution Health Savings Accounts with Integrated Rx
Personal Choice HDHP HD1-HC1 - Contract Year
Personal Choice HDHP HD1-HC2 - Contract Year
Personal Choice HDHP HD2-HC1 - Contract Year
Personal Choice HDHP HD2-HC2 - Contract Year
Personal Choice HDHP HD3-HC1 - Contract Year
Personal Choice HDHP HD3-HC2 - Contract Year
Personal Choice HDHP HD4-HC1 - Contract Year
Personal Choice HDHP HD4-HC2 - Contract Year
Personal Choice Prescription (Rx) Benefit Summaries
Personal Choice Select Rx $15/$35/$50 with oral contraceptives (Option 2)
Personal Choice Select Rx $20/$40/$60 (Option 3)
Personal Choice Select $250 Ded/$20/$40/$60 Rx with oral contraceptives (Option 4)
IBC Vision Benefit Summaries
$35 Vision Biennial Program
$50 Vision Biennial Program
$75 Vision Biennial Program
$100 Vision Biennial Program
$125 Vision Biennial Program
$200 Vision Biennial Program
$250 Vision Biennial Program
Previously Grandfathered Plans:
Personal Choice 5
Personal Choice 10
Personal Choice 15
Personal Choice 20
Personal Choice 310
Personal Choice 320
Personal Choice 5-15-70
Personal Choice 10-20-70
Personal Choice 15-25-70
Personal Choice 20-30-70
Personal Choice Option I
Personal Choice Option III
Personal Choice Option V
Personal Choice High Deductible 520-80-50
Personal Choice High Deductible 1020-80-50
Personal Choice High Deductible 2020-80-50
Personal Choice High Deductible 2520-80-50
Personal Choice Select Rx $5/$10 with oral contraceptives
Personal Choice Select Rx $5/$20 with oral contraceptives
Personal Choice Select Rx $10/$15 with oral contraceptives
Personal Choice Select Rx $10/$20 with oral contraceptives
Personal Choice Select Rx 50% with oral contraceptives
Personal Choice Select Rx $5/$10/$25 with oral contraceptives
Personal Choice Select Rx $5/$15/$25 with oral contraceptives
Personal Choice Select Rx $5/$20/$35 with oral contraceptives
Personal Choice Select Rx $10/$30/$50 with oral contraceptives
Personal Choice Select Rx $5/$30/$50 with oral contraceptives
Personal Choice Select Rx $0/$25/$50 with oral contraceptives
Personal Choice Select Rx $5/$40/$60 with oral contraceptives
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