SimplyBlue Guaranteed Issue

Select Plan to Review

*RX Coverage: Generic/Preferred Brand/Non-Preferred Brand Copay.

When you click on one of the View buttons below your Summary of Benefits and Coverage (SBC) will pull up in PDF format.

  Plan Number Network Maternity In-Network Deductible Amount Primary Care Practitioner/Specialist Copay Coinsurance Percent Out-of-Pocket Maximum RX Coverage*
View T1 S No $1500 Individual/$3000 Family Deductible/Coinsurance 20% $6500 Individual/$13000 Family Non-Covered
View T2 S No $2500 Individual/$5000 Family Deductible/Coinsurance 20% $7500 Individual / $15000 Family Non-Covered
View T3 S No $3500 Individual/$7000 Family Deductible/Coinsurance 20% $8500 Individual/$17000 Family Non-Covered