Page 42 - Rx Drug Plan review for John

11/14/21, 9:56 AM MSRG_II
COLONIAL PENN LIFE INSURANCE COMPANY - Methodology: AA
(800)523-9100
0 $1,892 $2,436 - $2,086 $2,692 $543 $2,502 $503 $842 $1,771 $2,219 $1,719

Restrictions Effective Date: 01/01/2021
COLONIAL PENN LIFE INSURANCE COMPANY - Methodology: AA
(800)523-9100

0 - - - - - - - $503 - - - -
Restrictions Effective Date: 04/20/2020
COMBINED INSURANCE COMPANY OF Methodology: AA
AMERICA - (855) 278-9329

0 $1,819 - - - $2,527 - $2,117 - - - - $1,769
Restrictions Effective Date: 11/01/2020

CONTINENTAL LIFE INSURANCE COMPANY OF Methodology: AA
BRENTWOOD, TENNESSEE - (800) 264-4000

0 $2,012 $2,542 - - $3,563 $666 $2,611 - - - - $1,795
Restrictions Effective Date: 09/01/2021

EVERENCE ASSOCIATION, INC. - (800) 348-7468 Methodology: AA

0 $2,257 - - - $2,651 - $2,477 - - - - $1,833
Restrictions Effective Date: 04/01/2021

FIRST HEALTH LIFE & HEALTH INSURANCE Methodology: AA
COMPANY - (855) 369-4835

0 $1,991 $2,288 - - $2,740 - $2,468 - - - - $1,457

Restrictions Effective Date: 04/01/2021
GARDEN STATE LIFE INSURANCE COMPANY - Methodology: AA
(844) 639-3648
0 $1,742 - - - $2,925 - $2,189 $692 - - $1,843 $1,809

Restrictions Effective Date: 01/01/2021
GLOBE LIFE AND ACCIDENT INSURANCE Methodology: AA
COMPANY - (800) 801-6831

60 $1,324 $1,832 $2,012 - $2,027 $406 $1,814 $436 - - - $1,502
Restrictions Effective Date: 06/01/2020

HEALTH NET LIFE INSURANCE COMPANY - (800) Methodology: AA
926-4178

0 $1,608 - - $2,004 $2,304 $972 $2,124 - - - - $1,788

Restrictions Effective Date: 01/01/2020
HUMANA BENEFIT PLAN OF ILLINOIS INC - (888) Methodology: AA
310-8482
90 $2,345 - - - $2,871 - $2,494 $839 - - - $1,949

Restrictions Effective Date: 06/01/2021

https://interactive.web.insurance.ca.gov/apex_extprd/f?p=111:31:11502158414098::NO::P31_SUBMIT:Y 2/4