• You Pay:
  25% after meeting the calendar year deductible
• We Pay:
  75% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  25% after meeting the calendar year deductible
• We Pay:
  75% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  25% after meeting the calendar year deductible
• We Pay:
  75% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  25% after meeting the calendar year deductible
• We Pay:
  75% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  Specialist: $75 copay
• We Pay:
  100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

For complete coverage details see the Prescription Drug List for this plan.

• Tier 1

  • You Pay:
    $20 copay
  • We Pay:
    100% after copay/coinsurance

• Tier 2

  • You Pay:
    $30 copay
  • We Pay:
    100% after copay/coinsurance

• Tier 3

  • You Pay:
    25% after meeting the calendar year deductible
  • We Pay:
    75% after meeting the calendar year deductible

• Tier 4

  • You Pay:
    25% after meeting the calendar year deductible
  • We Pay:
    75% after meeting the calendar year deductible

• Tier 5

  • You Pay:
    25% after meeting the calendar year deductible
  • We Pay:
    75% after meeting the calendar year deductible

• Tier 6

  • You Pay:
    25% after meeting the calendar year deductible
  • We Pay:
    75% after meeting the calendar year deductible

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  25% after meeting the calendar year deductible
• We Pay:
  75% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  25% after meeting the calendar year deductible
• We Pay:
  75% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

Learn More About Preventive Services and Preventive Drugs coverage for this plan.

• You Pay:
  $0
• We Pay:
  100%

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

Limited to members up to the end of the month in which the member turns 19.

• Routine Dental Cleaning

  • You Pay:
    $0 
  • We Pay:
    100%

• Yearly Eye Exam

  • You Pay:
    25% after meeting the calendar year deductible
  • We Pay:
    75% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.