| Product Name | Effective as of 7/01/09 |
|---|---|
| HMO Blue $500 Deductible | Summary of Benefits |
| HMO Blue New England $1000 Deductible | Summary of Benefits |
| HMO Blue $2,000 Deductible | Summary of Benefits |
| HMO Blue Basic Value | Summary of Benefits |
| HMO Blue New England $500 Deductible | Summary of Benefits |
| HMO Blue $1000 Plan-Year Deductible | Summary of Benefits |
| HMO Blue Enhanced Value | Summary of Benefits |
| HMO Blue New England Enhanced Value | Summary of Benefits |
| HMO Blue New England OptionsSM v2 | Summary of Benefits |
| HMO Blue OptionsSM v2 | Summary of Benefits |
| HMO Blue New England Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue New England Value | Summary of Benefits |
| HMO Blue New England Value Plus | Summary of Benefits |
| HMO Blue New England Premier Value | Summary of Benefits |
| HMO Blue Premium | Summary of Benefits |
| HMO Blue Premier Value | Summary of Benefits |
| HMO Blue Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue ValueSM | Summary of Benefits |
| HMO Blue ValueSM Plus | Summary of Benefits |
| HMO Blue ValueSM with Basic Rx | Summary of Benefits |
| Product Name | Effective as of 10/01/09 for 1-50 Employees |
|---|---|
| HMO Blue $500 Deductible | Summary of Benefits |
| HMO Blue New England $1000 Deductible | Summary of Benefits |
| HMO Blue $2,000 Deductible | Summary of Benefits |
| HMO Blue Basic Value | Summary of Benefits |
| HMO Blue New England $500 Deductible | Summary of Benefits |
| HMO Blue $1000 Plan-Year Deductible | Summary of Benefits |
| HMO Blue Enhanced Value | Summary of Benefits |
| HMO Blue New England Enhanced Value | Summary of Benefits |
| HMO Blue New England Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue New England Premier Value | Summary of Benefits |
| HMO Blue New England Value | Summary of Benefits |
| HMO Blue New England Value Plus | Summary of Benefits |
| HMO Blue Premium | Summary of Benefits |
| HMO Blue Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue Premier Value | Summary of Benefits |
| HMO Blue ValueSM | Summary of Benefits |
| HMO Blue ValueSM Plus | Summary of Benefits |
| HMO Blue ValueSM with Basic Rx | Summary of Benefits |
| HMO Blue Options v3 | Summary of Benefits |
| HMO Blue New England Options v3 | Summary of Benefits |
| Product Name | Effective as of 10/01/09 for 51+ Employees |
|---|---|
| HMO Blue $500 Deductible | Summary of Benefits |
| HMO Blue New England $1000 Deductible | Summary of Benefits |
| HMO Blue $2,000 Deductible | Summary of Benefits |
| HMO Blue Basic Value | Summary of Benefits |
| HMO Blue New England $500 Deductible | Summary of Benefits |
| HMO Blue $1000 Plan-Year Deductible | Summary of Benefits |
| HMO Blue Enhanced Value | Summary of Benefits |
| HMO Blue New England Enhanced Value | Summary of Benefits |
| HMO Blue New England Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue New England Premier Value | Summary of Benefits |
| HMO Blue New England Value | Summary of Benefits |
| HMO Blue New England Value Plus | Summary of Benefits |
| HMO Blue Premium | Summary of Benefits |
| HMO Blue Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue Premier Value | Summary of Benefits |
| HMO Blue ValueSM | Summary of Benefits |
| HMO Blue ValueSM Plus | Summary of Benefits |
| HMO Blue ValueSM with Basic Rx | Summary of Benefits |
| HMO Blue Options v3 | Summary of Benefits |
| HMO Blue New England Options v3 | Summary of Benefits |
| Product Name | Effective as of 01/01/10 for 1-50 Employees |
|---|---|
| HMO Blue $500 Deductible | Summary of Benefits |
| HMO Blue Basic Value | Summary of Benefits |
| HMO Blue $1000 Plan-Year Deductible | Summary of Benefits |
| HMO Blue Premium | Summary of Benefits |
| HMO Blue Value with BlueValue Rx | Summary of Benefits |
| HMO Blue New England $1000 Deductible | Summary of Benefits |
| HMO Blue $2,000 Deductible | Summary of Benefits |
| HMO Blue New England $500 Deductible | Summary of Benefits |
| HMO Blue Enhanced Value | Summary of Benefits |
| HMO Blue New England Enhanced Value | Summary of Benefits |
| HMO Blue New England Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue New England Premier Value | Summary of Benefits |
| HMO Blue New England Value | Summary of Benefits |
| HMO Blue New England Value Plus | Summary of Benefits |
| HMO Blue Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue Premier Value | Summary of Benefits |
| HMO Blue ValueSM | Summary of Benefits |
| HMO Blue ValueSM Plus | Summary of Benefits |
| HMO Blue ValueSM with Basic Rx | Summary of Benefits |
| HMO Blue Options v3 | Summary of Benefits |
| HMO Blue New England Options v3 | Summary of Benefits |
| Product Name | Effective as of 01/01/10 for 50+ Employees |
|---|---|
| HMO Blue $500 Deductible | Summary of Benefits |
| HMO Blue Basic Value | Summary of Benefits |
| HMO Blue $1000 Plan-Year Deductible | Summary of Benefits |
| HMO Blue Premium | Summary of Benefits |
| HMO Blue Value with BlueValue Rx | Summary of Benefits |
| HMO Blue New England $1000 Deductible | Summary of Benefits |
| HMO Blue $2,000 Deductible | Summary of Benefits |
| HMO Blue New England $500 Deductible | Summary of Benefits |
| HMO Blue Enhanced Value | Summary of Benefits |
| HMO Blue New England Enhanced Value | Summary of Benefits |
| HMO Blue New England Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue New England Premier Value | Summary of Benefits |
| HMO Blue New England Value | Summary of Benefits |
| HMO Blue New England Value Plus | Summary of Benefits |
| HMO Blue Premier Value with Coinsurance | Summary of Benefits |
| HMO Blue Premier Value | Summary of Benefits |
| HMO Blue ValueSM | Summary of Benefits |
| HMO Blue ValueSM Plus | Summary of Benefits |
| HMO Blue ValueSM with Basic Rx | Summary of Benefits |
| HMO Blue Options v3 | Summary of Benefits |
| HMO Blue New England Options v3 | Summary of Benefits |
| Closed Plans | Prior to 7/01/09 | Effective as of 07/01/09 | Effective as of 10/01/09 for 1-50 Employees |
Effective as of 10/01/09 for 51+ Employees |
|---|---|---|---|---|
| HMO Blue Basic Value with Rx | Summary of Benefits | |||
| HMO Blue Basic Value w/o Rx | Summary of Benefits | Summary of Benefits | ||
| HMO Blue $5 Copayment Plan | Summary of Benefits | Summary of Benefits | ||
| HMO Blue $10 | Summary of Benefits | |||
| HMO Blue NE $5 Copayment Plan | Summary of Benefits | Summary of Benefits | ||
| HMO Blue NE $10 | Summary of Benefits | |||
| HMO Blue Preferences w/ $350 Option | Summary of Benefits | Summary of Benefits | ||
| HMO Blue Preferences $600 | Summary of Benefits | Summary of Benefits | ||
| HMO Blue New England $1000 Calendar-Year Deductible | Summary of Benefits | |||
| HMO Blue $1000 Calendar-Year Deductible | Summary of Benefits | |||
| HMO Blue $2000 Calendar-Year Deductible | Summary of Benefits | |||
| HMO Blue New England Premier Value | Summary of Benefits | Summary of Benefits | ||
| HMO Blue Premier Value | Summary of Benefits | Summary of Benefits |