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Benefit Highlight Sheets - Blue Advantage Entrepreneur
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| Benefit Highlight Sheets - Blue Advantage Entrepreneur |
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If your group's current benefit plan is not listed, please contact your Account Representative or General Agent.
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Blue Advantage Entrepreneur
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Form Name |
File Size |
Form Number |
Date |
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BAE PPO Presale Employer
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BAE Plan Map Chart
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83K |
-- |
07/05 |
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BAE PPO 100/80 Coinsurance with $10 Copay
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BAE $0 Deductible with $0 OPX ( Plan 102, 103)
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207K |
20344 |
09/05 |
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BAE $250 Deductible with $0 OPX (Plans 108, 109)
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208K |
20345 |
09/05 |
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BAE $500 Deductible with $0 OPX (Plans 111, 112)
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207K |
20346 |
09/05 |
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BAE PPO 90/70 Coinsurance with $10 Copay
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BAE $0 Deductible with $1,000 OPX (Plans 12312, 12313)
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209K |
20305 |
09/05 |
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BAE $250 Deductible with $1,000 OPX (Plans 42312, 42313)
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209K |
20306 |
09/05 |
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BAE $500 Deductible with $1,000 OPX (Plans 72312, 72313)
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209K |
20307 |
09/05 |
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BAE $1,000 Deductible with $1,000 OPX (Plans 82312, 82313)
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209K |
20308 |
09/05 |
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BAE $1,500 Deductible with $2,000 OPX (Plans 92412, 92413)
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197K |
20309 |
09/05 |
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BAE $2,500 Deductible with $2,000 OPX (Plans C2412, C2413)
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209K |
20310 |
09/05 |
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BAE PPO 90/70 Coinsurance with $20 Copay
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BAE $0 Deductible with $1,000 OPX (Plans 12322, 12323)
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208K |
20311 |
09/05 |
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BAE $250 Deductible with $1,000 OPX (Plans 42322, 42323)
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208K |
20312 |
09/05 |
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BAE $500 Deductible with $1,000 OPX (Plans 72322, 72323)
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208K |
20313 |
09/05 |
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BAE $1,000 Deductible with $1,000 OPX (Plans 82322, 82323)
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208K |
20314 |
09/05 |
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BAE $1,500 Deductible with $2,000 OPX (Plans 92422, 92423)
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208K |
20315 |
09/05 |
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BAE $2,500 Deductible with $2,000 OPX (Plans C2422, C2423)
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208K |
20316 |
09/05 |
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BAE PPO 80/60 Coinsurance with $20 Copay
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BAE $250 Deductible with $2,000 OPX (Plans 43422, 43423, 43424)
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208K |
20317 |
09/05 |
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BAE $500 Deductible with $2,000 OPX (Plans 73422, 73423, 73424)
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208K |
20318 |
09/05 |
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BAE $1,000 Deductible with $2,000 OPX (Plans 83422, 83423, 83424)
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209K |
20319 |
09/05 |
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BAE $1,500 Deductible with $2,000 OPX (Plans 93422, 93423, 93424)
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209K |
20320 |
09/05 |
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BAE $2,500 Deductible with $2,000 OPX (Plans C3422, C3423, C3424)
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208K |
20321 |
09/05 |
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BAE PPO 80/60 Coinsurance with $30 Copay
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BAE $250 Deductible with $2,000 OPX (Plans 43432, 43433, 43434)
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207K |
20322 |
09/05 |
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BAE $500 Deductible with $2,000 OPX (Plans 73432, 73433, 73434)
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207K |
20323 |
09/05 |
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BAE $1,000 Deductible with $2,000 OPX (Plans 83432, 83433, 83434)
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207K |
20324 |
09/05 |
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BAE $1,500 Deductible with $2,000 OPX (Plans 93432, 93433, 93434)
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207K |
20325 |
09/05 |
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BAE $2,500 Deductible with $2,000 OPX (Plans C3432, C3433, C3434)
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207K |
20326 |
09/05 |
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PPO Value Choice
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$2,500 Deductible with $2,500 OPX (Plan E2VC3705)
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28K |
20302 |
09/05 |
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$5,000 Deductible with $ 5,000 OPX (Plan E2VH3805)
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28K |
20303 |
09/05 |
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Prescription Drug Employee
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$10/$20/$35 Rx Highlight Sheet
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93K |
20333 |
10/05 |
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$15/$30/$50 Rx Highlight Sheet
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93K |
20334 |
10/05 |
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$15/35%/50% Rx Highlight Sheet
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102K |
20335 |
10/05 |
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