INDIVIDUALS AND FAMILY – SUMMARY OF BENEFITS AND COVERAGE

 

To view an SBC, select a link under Name and click the plan. To sort Blue KC plans, scroll over the State, Plan Name, Individual Deductible, or Name.

 

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KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK5266A)
$10,000.00
  
KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK5266A)
$10,000.00
  
KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK7010A)
$10,000.00
  
KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK7010A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM5269A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM5269A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM7013A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM7013A)
$10,000.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE  (PBM5267A)
$2,500.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE  (PBM5267A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK5264A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK5264A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK7008A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK7008A)
$2,500.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE (PBM7011A)
$2,500.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE (PBM7011A)
$2,500.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM5268A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM5268A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM7012A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM7012A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM7012A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK5265A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK5265A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK7009A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK7009A)
$5,000.00
  
MOAFFORDABLUE PCB $10,000 DEDUCTIBLE (PBM4001A)
$10,000.00
  
MOAFFORDABLUE PCB $10,000 DEDUCTIBLE (PBM4001A)
$10,000.00
  
MOAFFORDABLUE PCB $2,500 DEDUCTIBLE  (PBM3999A)
$2,500.00
  
MOAFFORDABLUE PCB $2,500 DEDUCTIBLE  (PBM3999A)
$2,500.00
  
MOAFFORDABLUE PCB $5,000 DEDUCTIBLE  (PBM4000A)
$5,000.00
  
MOAFFORDABLUE PCB $5,000 DEDUCTIBLE  (PBM4000A)
$5,000.00
  
KSBlue Care HMO -  Kansas Plan (BCK1213A)
$0.00
  
KSBlue Care HMO -  Kansas Plan (BCK1213A)
$0.00
  
KSBlue Care HMO -  Kansas Plan (BCK1214A)
$0.00
  
MOBlue Care HMO Missouri Plan (BCM1214A)
$0.00
  
MOBLUE4U $1,000 DEDUCTIBLE  (PAM0016A)
$1,000.00
  
MOBLUE4U $1,000 DEDUCTIBLE  (PAM0106A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0014A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0014A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0086A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0086A)
$1,000.00
  
MOBLUE4U $2,500 DED Rate Guaranteed (PAM0003A)
$2,500.00
  
MOBLUE4U $2,500 DED Rate Guaranteed (PAM0003A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0011A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0011A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0018A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0018A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0107A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0107A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0001A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0001A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0009A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0009A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0087A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0087A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE RATE GUARANTEE (PAK0017A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE RATE GUARANTEE (PAK0017A)
$2,500.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0020A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0020A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0108A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0108A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0002A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0002A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0010A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0010A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0088A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0088A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0004A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0004A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0012A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0012A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE RATE GUARANTEE (PAK0019A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE RATE GUARANTEE (PAK0019A)
$5,000.00
  
KSBLUE4U $500 DEDUCTIBLE (PAK0013A)
$1,000.00
  
KSBLUE4U $500 DEDUCTIBLE (PAK0013A)
$1,000.00
  
MOBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (NON SINGLE BELOW INDEX) (PBMHB01A)
$1,500.00
  
KSBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (NON SINGLE BELOW INDEX) (PBKHA96A)
$1,500.00
  
MOBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (NON SINGLE BELOW INDEX) (PBMH734A)
$1,500.00
  
KSBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (NON SINGLE BELOW INDEX) (PBKHA93A)
$1,500.00
  
KSBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (NON SINGLE BELOW INDEX) (PBKH730A)
$1,500.00
  
KSBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (NON SINGLE BELOW INDEX) (PBKH729A)
$1,500.00
  
MOBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (NON SINGLE BELOW INDEX) (PBMH734A)
$1,500.00
  
MOBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (NON SINGLE BELOW INDEX) (PBMHB01A)
$1,500.00
  
MOBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (SINGLE BELOW INDEX) (PBMHA97A)
$1,500.00
  
MOBLUESAVER PLAN 1 $1,500 DEDUCTIBLE (SINGLE BELOW INDEX) (PBMH733A)
$1,500.00
  
KSBLUESAVER PLAN 2 $3,000 DEDUCTIBLE (ABOVE INDEX) (PBKHA95A)
$3,000.00
  
MOBLUESAVER PLAN 2 $3,000 DEDUCTIBLE (ABOVE INDEX) (PBMHA99A)
$3,000.00
  
MOBLUESAVER PLAN 2 $3,000 DEDUCTIBLE (ABOVE INDEX) (PBMH736A)
$3,000.00
  
KSBLUESAVER PLAN 2 $3,000 DEDUCTIBLE (ABOVE INDEX) (PBKH732A)
$3,000.00
  
MOBLUESAVER PLAN 3 $5,000 DEDUCTIBLE (ABOVE INDEX) (PBMHA98A)
$5,000.00
  
MOBLUESAVER PLAN 3 $5,000 DEDUCTIBLE (ABOVE INDEX) (PBMH735A)
$5,000.00
  
KSBLUESAVER PLAN 3 $5,000 DEDUCTIBLE (ABOVE INDEX) (PBKHA94A)
$5,000.00
  
KSBLUESAVER PLAN 3 $5,000 DEDUCTIBLE (ABOVE INDEX) (PBKH731A)
$5,000.00
  
KSPCB $1,000 DEDUCTIBLE KS (PBK2670A)
$1,000.00
  
KSPCB $1,000 DEDUCTIBLE KS (PBK2670A)
$1,000.00
  
KSPCB $1,000 DEDUCTIBLE KS (RATESAVER) (PBK2676A)
$1,000.00
  
KSPCB $1,500 DEDUCTIBLE KS (PBK2671A)
$1,500.00
  
KSPCB $1,500 DEDUCTIBLE KS (PBK2671A)
$1,500.00
  
KSPCB $1,500 DEDUCTIBLE KS (RATESAVER) (PBK2677A)
$1,500.00
  
KSPCB $10,000 DEDUCTIBLE KS (AFFORDABLUE)(PBK3998A)
$10,000.00
  
KSPCB $10,000 DEDUCTIBLE KS (AFFORDABLUE)(PBK3998A)
$10,000.00
  
KSPCB $10,000 DEDUCTIBLE KS (RATESAVER) (PBK3062A)
$10,000.00
  
KSPCB $10,000 DEDUCTIBLE KS (RATESAVER) (PBK2680A)
$10,000.00
  
KSPCB $10,000 DEDUCTIBLE KS (RATESAVER) (PBK3062A)
$10,000.00
  
KSPCB $10,000 DEDUCTIBLE KS (RATESAVER) (PBK2680A)
$10,000.00
  
KSPCB $2,500 DEDUCTIBLE KS (AFFORDABLUE) (PBK3996A)
$2,500.00
  
KSPCB $2,500 DEDUCTIBLE KS (AFFORDABLUE) (PBK3996A)
$2,500.00
  
KSPCB $2,500 DEDUCTIBLE KS (PBK3058A)
$5,000.00
  
KSPCB $2,500 DEDUCTIBLE KS (PBK3058A)
$5,000.00
  
KSPCB $2,500 DEDUCTIBLE KS (RATESAVER) (PBK3060A)
$2,500.00
  
KSPCB $2,500 DEDUCTIBLE KS (RATESAVER) (PBK2678A)
$2,500.00
  
KSPCB $250 DEDUCTIBLE KS (PBK2667A)
$250.00
  
KSPCB $250 DEDUCTIBLE KS (PBK2667A)
$250.00
  
KSPCB $5,000 DEDUCTIBLE KS (AFFORDABLUE) (PBK3997A)
$5,000.00
  
KSPCB $5,000 DEDUCTIBLE KS (AFFORDABLUE) (PBK3997A)
$5,000.00
  
KSPCB $5,000 DEDUCTIBLE KS (PBK2673A)
$5,000.00
  
KSPCB $5,000 DEDUCTIBLE KS (PBK3059A)
$5,000.00
  
KSPCB $5,000 DEDUCTIBLE KS (PBK3059A)
$5,000.00
  
KSPCB $5,000 DEDUCTIBLE KS (RATESAVER) (PBK3061A)
$5,000.00
  
KSPCB $5,000 DEDUCTIBLE KS (RATESAVER) (PBK2679A)
$5,000.00
  
KSPCB $500 DEDUCTIBLE KS (PBK2668A)
$500.00
  
KSPCB $500 DEDUCTIBLE KS (PBK2668A)
$500.00
  
KSPCB $500 DEDUCTIBLE KS (RATESAVER) (PBK2674A)
$500.00
  
KSPCB $750 DEDUCTIBLE KS (PBK2669A)
$1,000.00
  
KSPCB $750 DEDUCTIBLE KS (PBK2669A)
$1,000.00
  
KSPCB $750 DEDUCTIBLE KS (RATESAVER) (PBK2675A)
$750.00
  
KSPCB KS PLAN 1, $3000 DEDUCTIBLE (NON-SINGLE, BELOW INDEX) (PBKH006A)
$1,500.00
  
KSPCB KS-PLAN 1, 1500 DEDUCTIBLE (SINGLE, BELOW INDEX) (PBKH005A)
$1,500.00
  
KSPCB KS-PLAN 2, $3000 DEDUCTIBLE (ABOVE INDEX) (PBKH004A)
$3,000.00
  
KSPCB KS-PLAN 3, 5000 DEDUCTIBLE (ABOVE INDEX) (PBKH003A)
$5,000.00
  
KSPCB KS-PLAN 3, 5000 DEDUCTIBLE (ABOVE INDEX) (PBKH003A)
$5,000.00
  
KSPCB KS-PLAN 3, 5000 DEDUCTIBLE (ABOVE INDEX) (PBKH003A)
$5,000.00
  
MOPCB MO-PLAN 1, 1500 DEDUCTIBLE (SINGLE, BELOW INDEX)(PBMH005A)
$1,500.00
  
MOPCB MO-PLAN 1, 3000 DEDUCTIBLE (NON-SINGLE, BELOW INDEX) (PBMH006A)
$1,500.00
  
MOPCB MO-PLAN 1, 3000 DEDUCTIBLE (NON-SINGLE, BELOW INDEX) (PBMH006A)
$1,500.00
  
MOPCB MO-PLAN 2, 3000 DEDUCTIBLE (ABOVE INDEX) (PBMH004A)
$3,000.00
  
MOPCB MO-PLAN 3, $5,000 DEDUCTIBLE (ABOVE INDEX) (PBMH003A)
$5,000.00
  
MOPREMIUM PCB $1,000 DEDUCTIBLE (PBM2684A)
$1,000.00
  
MOPREMIUM PCB $1,000 DEDUCTIBLE (PBM2684A)
$1,000.00
  
MOPREMIUM PCB $1,500 DEDUCTIBLE (PBM2685A)
$1,500.00
  
MOPREMIUM PCB $1,500 DEDUCTIBLE (PBM2685A)
$1,500.00
  
MOPREMIUM PCB $2,500 DEDUCTIBLE (PBM3058A)
$2,500.00
  
MOPREMIUM PCB $2,500 DEDUCTIBLE (PBM3058A)
$2,500.00
  
MOPREMIUM PCB $250 DEDUCTIBLE (PBM2681A)
$250.00
  
MOPREMIUM PCB $250 DEDUCTIBLE (PBM2681A)
$250.00
  
MOPREMIUM PCB $5,000 DEDUCTIBLE (PBM2687A)
$5,000.00
  
MOPREMIUM PCB $5,000 DEDUCTIBLE (PBM2687A)
$5,000.00
  
MOPREMIUM PCB $5,000 DEDUCTIBLE (PBM3059A)
$5,000.00
  
MOPREMIUM PCB $5,000 DEDUCTIBLE (PBM3059A)
$5,000.00
  
MOPREMIUM PCB $500 DEDUCTIBLE (PBM2682A)
$500.00
  
MOPREMIUM PCB $500 DEDUCTIBLE (PBM2682A)
$500.00
  
MOPREMIUM PCB $750 DEDUCTIBLE (PBM2683A)
$750.00
  
MOPREMIUM PCB $750 DEDUCTIBLE (PBM2683A)
$750.00
  
KSPREMIUM PLAN $1,000 DEDUCTIBLE (PBK5276A)
$1,000.00
  
KSPREMIUM PLAN $1,000 DEDUCTIBLE (PBK5276A)
$1,000.00
  
KSPREMIUM PLAN $1,000 DEDUCTIBLE (PBK7018A)
$1,000.00
  
KSPREMIUM PLAN $1,000 DEDUCTIBLE (PBK7018A)
$1,000.00
  
MOPREMIUM PLAN $1,000 DEDUCTIBLE (PBM5282A)
$1,000.00
  
MOPREMIUM PLAN $1,000 DEDUCTIBLE (PBM5282A)
$1,000.00
  
MOPREMIUM PLAN $1,000 DEDUCTIBLE (PBM7024A)
$1,000.00
  
MOPREMIUM PLAN $1,000 DEDUCTIBLE (PBM7024A)
$1,000.00
  
KSPREMIUM PLAN $1,500 DEDUCTIBLE (PBK5277A)
$1,500.00
  
KSPREMIUM PLAN $1,500 DEDUCTIBLE (PBK5277A)
$1,500.00
  
KSPREMIUM PLAN $1,500 DEDUCTIBLE (PBK7019A)
$1,500.00
  
KSPREMIUM PLAN $1,500 DEDUCTIBLE (PBK7019A)
$1,500.00
  
MOPREMIUM PLAN $1,500 DEDUCTIBLE (PBM5283A)
$1,500.00
  
MOPREMIUM PLAN $1,500 DEDUCTIBLE (PBM5283A)
$1,500.00
  
MOPREMIUM PLAN $1,500 DEDUCTIBLE (PBM7025A)
$1,500.00
  
MOPREMIUM PLAN $1,500 DEDUCTIBLE (PBM7025A)
$1,500.00
  
KSPREMIUM PLAN $2,500 DEDUCTIBLE (PBK5278A)
$2,500.00
  
KSPREMIUM PLAN $2,500 DEDUCTIBLE (PBK5278A)
$2,500.00
  
KSPREMIUM PLAN $2,500 DEDUCTIBLE (PBK7020A)
$2,500.00
  
KSPREMIUM PLAN $2,500 DEDUCTIBLE (PBK7020A)
$2,500.00
  
MOPREMIUM PLAN $2,500 DEDUCTIBLE (PBM5284A)
$2,500.00
  
MOPREMIUM PLAN $2,500 DEDUCTIBLE (PBM5284A)
$2,500.00
  
MOPREMIUM PLAN $2,500 DEDUCTIBLE (PBM7026A)
$2,500.00
  
MOPREMIUM PLAN $2,500 DEDUCTIBLE (PBM7026A)
$2,500.00
  
KSPREMIUM PLAN $5,000 DEDUCTIBLE (PBK5279A)
$5,000.00
  
KSPREMIUM PLAN $5,000 DEDUCTIBLE (PBK5279A)
$5,000.00
  
KSPREMIUM PLAN $5,000 DEDUCTIBLE (PBK7021A)
$5,000.00
  
KSPREMIUM PLAN $5,000 DEDUCTIBLE (PBK7021A)
$5,000.00
  
MOPREMIUM PLAN $5,000 DEDUCTIBLE (PBM5285A)
$5,000.00
  
MOPREMIUM PLAN $5,000 DEDUCTIBLE (PBM5285A)
$5,000.00
  
MOPREMIUM PLAN $5,000 DEDUCTIBLE (PBM7027A)
$5,000.00
  
MOPREMIUM PLAN $5,000 DEDUCTIBLE (PBM7027A)
$5,000.00
  
KSPREMIUM PLAN $500 DEDUCTIBLE (PBK5274A)
$500.00
  
KSPREMIUM PLAN $500 DEDUCTIBLE (PBK5274A)
$500.00
  
MOPREMIUM PLAN $500 DEDUCTIBLE (PBM5280A)
$500.00
  
MOPREMIUM PLAN $500 DEDUCTIBLE (PBM5280A)
$500.00
  
MOPREMIUM PLAN $500 DEDUCTIBLE (PBM7022A)
$500.00
  
MOPREMIUM PLAN $500 DEDUCTIBLE (PBM7022A)
$500.00
  
MOProd Checkout 19.2.1.0 jmcCopy
$1,500.00
  
MOProd Checkout 19.2.1.0
$1,500.00
  
KSRATE SAVER PLAN $1,000 DEDUCTIBLE (PBK5288A)
$1,000.00
  
KSRATE SAVER PLAN $1,000 DEDUCTIBLE (PBK7030A)
$1,000.00
  
KSRATE SAVER PLAN $1,500 DEDUCTIBLE (PBK5289A)
$1,500.00
  
KSRATE SAVER PLAN $2,500 DEDUCTIBLE (PBK5290A)
$2,500.00
  
KSRATE SAVER PLAN $2,500 DEDUCTIBLE (PBK7032A)
$2,500.00
  
KSRATE SAVER PLAN $5,000 DEDUCTIBLE (PBK5291A)
$5,000.00
  
KSRATE SAVER PLAN $5,000 DEDUCTIBLE (PBK7033A)
$5,000.00
  
MORATESAVER PCB $1,000 DEDUCTIBLE (PBM2690A)
$1,000.00
  
MORATESAVER PCB $1,500 DEDUCTIBLE (PBM2691A)
$1,500.00
  
KSRATESAVER PCB $10,000 DEDUCTIBLE (PBK5292A)
$10,000.00
  
KSRATESAVER PCB $10,000 DEDUCTIBLE (PBK5292A)
$10,000.00
  
KSRATESAVER PCB $10,000 DEDUCTIBLE (PBK7034A)
$10,000.00
  
KSRATESAVER PCB $10,000 DEDUCTIBLE (PBK7034A)
$10,000.00
  
MORATESAVER PCB $10,000 DEDUCTIBLE (PBM2694A)
$10,000.00
  
MORATESAVER PCB $10,000 DEDUCTIBLE (PBM3062A)
$10,000.00
  
MORATESAVER PCB $2,500 DEDUCTIBLE (PBM2692A)
$2,500.00
  
MORATESAVER PCB $2,500 DEDUCTIBLE (PBM3060A)
$2,500.00
  
MORATESAVER PCB $5,000 DEDUCTIBLE (PBM2693A)
$5,000.00
  
MORATESAVER PCB $5,000 DEDUCTIBLE (PBM3061A)
$5,000.00
  
MORATESAVER PCB $500 DEDUCTIBLE (PBM2688A)
$500.00
  
MORATESAVER PCB $750 DEDUCTIBLE (PBM2689A)
$750.00
  
MORATESAVER PCB $750 DEDUCTIBLE (PBM2690A)
$750.00
  
MORATESAVER PLAN $1,000 DEDUCTIBLE  (PBM7037A)
$1,000.00
  
MORATESAVER PLAN $1,000 DEDUCTIBLE (PBM5295A)
$1,000.00
  
MORATESAVER PLAN $1,500 DEDUCTIBLE (PBM5296A)
$1,500.00
  
MORATESAVER PLAN $1,500 DEDUCTIBLE (PBM7038A)
$1,500.00
  
MORATESAVER PLAN $10,000 DEDUCTIBLE (PBM5299A)
$10,000.00
  
MORATESAVER PLAN $10,000 DEDUCTIBLE (PBM7041A)
$10,000.00
  
MORATESAVER PLAN $2,500 DEDUCTIBLE (PBM5297A)
$2,500.00
  
MORATESAVER PLAN $2,500 DEDUCTIBLE (PBM7039A)
$2,500.00
  
MORATESAVER PLAN $5,000 DEDUCTIBLE (PBM5298A)
$5,000.00
  
MORATESAVER PLAN $5,000 DEDUCTIBLE (PBM7040A)
$5,000.00
  
MORATESAVER PLAN $500 DEDUCTIBLE (PBM5293A)
$500.00
  
MORATESAVER PLAN $500 DEDUCTIBLE (PBM7035A)
$500.00