Standard Benefits Spreadsheet
For ALL groups as of 4/1/08
Service Area Map
Commonwealth Choice Plans Benefits Spreadsheet
Use starting 7/1/2007
Hospital Map
Standard Plans
HMO, PPO & HSA
Commonwealth Choice Plans,
plus
Select Care
Direct Care
Preferred Care
HMO
Premier
Also available without Rx
Premier
Also available without Rx
Premier
Premier
Premier Value
Premier Value
Premium Saver
Premium Saver 500
Premium Saver
Also available without Rx
Premium Saver
Also available without Rx
Premium Saver Value I
Direct Care
Premium Saver 500
Premium Saver Value I
Premium Saver Value I
Premium Saver Value II
Direct Care
Premium Saver 2000/500
Premium Saver Value II
Premium Saver Value II
Premium Saver Basic I
Select Care
Premium Saver 2000/500*
Premium Saver Basic I
Premium Saver Basic I
Premium Saver Basic II
Direct Care
Premium Saver 2000/500 no Rx
Premium Saver Basic II
Premium Saver Basic II
Premium Saver 500
Select Care
Premium Saver 2000/500 no Rx*
*Standard plan
Premium Saver 500
Premium Saver 500
Premium Saver 1000
Premium Saver 1000
Premium Saver 1000
Premium Saver 2000
Premium Saver 2000
Premium Saver 2000
Premium Saver 2000/500
Premium Saver 2000/500
Also available without Rx
Premium Saver 2000/500
Also available without Rx
HSA Care Choice 1250
Premium Saver 65/35
Premium Saver 65/35
HSA Care Choice 2000
HSA Care Choice 1250
HSA Care Choice 1250
Miscellaneous
HSA Care Choice 2000
HSA Care Choice 2000
Preventive/Diagnostic Guide - Select and Direct Plans
Additional PPO Plans
HSA
Preventive/Diagnostic Guide - Premium Saver Plans
500
Care Choice Overview
Preventive/Diagnostic Guide - Care Choice Plans
1000
HSA Overview
Guide to Hospitals/Medical Centers
Comparison Guide
$0 co-payment office visits