KM C654e-20181009135159… · 2019-01-15 · MPP1 1 $ 958 $ 1,724 $ 1,724 $ 2,682 Anthem BCBS...
Transcript of KM C654e-20181009135159… · 2019-01-15 · MPP1 1 $ 958 $ 1,724 $ 1,724 $ 2,682 Anthem BCBS...
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EPISCOPAL CHURCH MEDICAL TRUST2019 HEALTH PLANS
Diocese of the Rio Grande (0596)Effective Date: 2019-01-01
Rate Tiers: 3Rx Option: Standard
Last Modified: 2018-09-26
Single Plus Spouse Plus Child Family
Anthem BCBS BlueCard PPO 100 MPP1 1 958$ 1,724$ 1,724$ 2,682$
Anthem BCBS BlueCard PPO 70 MPP4 731$ 1,316$ 1,316$ 2,047$
Anthem BCBS BlueCard PPO 80 MPP3 802$ 1,444$ 1,444$ 2,246$ Anthem BCBS BlueCard PPO 90 MPP2 884$ 1,591$ 1,591$ 2,475$
Anthem BCBS CDHP-15/HAS MHDG 2 722$ 1,300$ 1,300$ 2,022$ EAP MEAP 5$ 5$ 5$ 5$
Anthem BCBS BlueCard MSP PPO 100 MSG9 767$ 1,381$ 1,381$ 2,148$
Anthem BCBS BlueCard MSP PPO 70 MS12 586$ 1,055$ 1,055$ 1,641$
Anthem BCBS BlueCard MSP PPO 80 MS11 642$ 1,156$ 1,156$ 1,798$ Anthem BCBS BlueCard MSP PPO 90 MS10 707$ 1,273$ 1,273$ 1,980$
Cigna Open Access Plus CDHP-15/H SA MCDH 722$ 1,300$ 1,300$ 2,022$
Cigna Open Access Plus MSP PPO 100 MGM1 767$ 1,381$ 1,381$ 2,148$
Cigna Open Access Plus MSP PPO 70 MGM4 586$ 1,055$ 1,055$ 1,641$
Cigna Open Access Plus MSP PPO 80 MGM3 642$ 1,156$ 1,156$ 1,798$ Cigna Open Access Plus MSP PPO 90 MGM2 707$ 1,273$ 1,273$ 1,980$
Cigna Open Access Plus PPO 100 MG01 958$ 1,724$ 1,724$ 2,682$
Cigna Open Access Plus PPO 70 MG04 731$ 1,316$ 1,316$ 2,047$
Cigna Open Access Plus PPO 80 MG03 802$ 1,444$ 1,444$ 2,246$ Cigna Open Access Plus PPO 90 MG02 884$ 1,591$ 1,591$ 2,475$
Preventive Dental DDPV 3 34$ 61$ 61$ 95$
Basic Dent-50/150 DD50 32 57$ 103$ 103$ 160$
Dent&Ortho-25/75 DD25 8 77$ 139$ 139$ 216$
PLANPLAN CODE
ENROLL TOTAL
2019
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