Tier 4 Info

4 Tier Plans:

Use this 4 Tier Covered Medications list if your plan is listed here and your benefit materials show that your prescription plan is based on a 4 Tier structure.

Blue Care Elect $3000 Deductible
Blue Care Elect $4500 Deductible
Blue Care Elect Enhanced Value
HMO Blue New England Premier Value with Co-insurance and HCCS
HMO Blue New England Premier Value with Co-insurance
HMO Blue New England Premier Value with HCCS
HMO Blue New England Premier Value
HMO Blue New England Value Plus
HMO Blue New England Enhanced Value
HMO Blue Premier Value
HMO Blue Value Plus
HMO Blue Enhanced Value
HMO Blue New England Options Deductible
HMO Blue New England Options Deductible II
HMO Blue New England Options Deductible III
HMO Blue $2000 Deductible with HCCS
HMO Blue $2000 Deductible
HMO Blue New England $1000 Deductible with HCCS
HMO Blue New England $1000 Deductible
HMO Blue New England $500 Deductible with HCCS
HMO Blue New England $500 Deductible
HMO Blue New England $2000 Deductible with HCCS
HMO Blue New England $2000 Deductible
HMO Blue Basic Copayment
HMO Blue Basic Co-insurance
HMO Blue New England $1000 Deductible with Co-insurance
HMO Blue New England $1000 Deductible with Co-insurance and HCCS
HMO Blue New England Basic Copayment
HMO Blue New England Basic Co-insurance
HMO Blue NE $3000 Deductible
HMO Blue NE $3000 Deductible with HCCS
HMO Blue New England $1500 Deductible
HMO Blue New England $1000 Deductible with Copayment
HMO Blue New England $2000 Deductible with Copayment
HMO Blue New England $1,000 Deductible with Copay with HCCS
HMO Blue New England $1,500 Deductible with HCCS
Access Blue Basic $2000
Access Blue Basic $2000 with HCCS
Access Blue Basic Saver
Access Blue New England Saver
Access Blue New England Basic Saver
Access Blue New England Basic $2000
Access Blue New England Basic $2000 with HCCS
Access Blue New England Basic Saver II
Access Blue New England Saver $2000
Access Blue New England Saver $2,500
Access Blue New England Saver $3,000
Preferred Blue PPO Options
Preferred Blue PPO Options Deductible II
Preferred Blue PPO Options Deductible III
Preferred Blue PPO Basic $2000 with HCCS
Preferred Blue PPO Basic $2000
Preferred Blue PPO $2000 Deductible with HCCS
Preferred Blue PPO $2000 Deductible
Preferred Blue PPO $1000 Deductible with HCCS
Preferred Blue PPO $1000 Deductible
Preferred Blue PPO $500 Deductible
Preferred Blue PPO $500 Deductible with HCCS
Preferred Blue PPO Basic Copayment
Preferred Blue PPO Basic Co-insurance
Preferred Blue PPO Saver $3000
Preferred Blue PPO Saver $2000
Preferred Blue PPO Saver $1500
Preferred Blue PPO Basic Saver