Model Memo to Accompany Summary of Benefits
PPO VS D2 (Out of Network) Effective Jan 1 2025
PPO VS D2 (Out of Network) 2024
PPO VS D2 (In Network) Effective Jan 1 2025
Over 65 PPO D-2 with Rx SBC Effective Jan 1 2025 - June 30 2025
Over 65 PPO D-2 with Rx SBC Effective Jan 1 2025 - June 30 2025
Over 65 PPO D-2 without Rx SBC Effective Jan 1 2025 - June 30 2025
Over 65 PPO D-2 without Rx SBC Effective July 1 2024 - December 31 2024
Over 65 PPO D-2 without Rx SBC Effective Jan 1 2025 - June 30 2025
Over 65 PPO D-2 without Rx SBC Effective July 1 2024 - December 31 2024
Over 65 PPO D-2 with Rx SBC Effective Jan 1 2025 - June 30 2025
Over 65 PPO D-2 with Rx SBC Effective July 1 2024 - December 31 2024
Under 65 PPO D-2 without Rx SBC Effective Jan 1 2025 - June 30 2025
Under 65 PPO D-2 without Rx SBC Effective July 1 2024 - December 31 2024
Under 65 PPO D-2 with Rx SBC Effective Jan 1 2025 - June 30 2025
Under 65 PPO D-2 with Rx SBC Effective July 1 2024 - December 31 2024
Under 65 PPO without Rx SBC Effective Jan 1 2025 - June 30 2025
Under 65 PPO without Rx SBC Effective July 1 2024 - December 31 2024
Under 65 PPO with Rx SBC Effective Jan 1 2025 - June 30 2025
Under 65 PPO with Rx SBC Effective July 1 2024 - December 31 2024