Arkansas BlueCross Blue Shield Medi-Pak Choice
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Plan Benefit In Network
Monthly premium
Physician office visits copay
Specialty physician office visit copay
Inpatient hospital admission daily copay for days 1-6
Out-of-pocket maximum
Prescription drug benefit*
Medi-Pak
Advantage MA (PFFS) 		Medi-Pak
Advantage
MA-PD
(PFFS)
Option 1		Medi-Pak
Advantage
MA-PD
(PFFS)
Option 2
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Detailed Plan Benefits
Detailed Prescription Drug Benefits
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Medi-Pak Advantage Rights and Benefits
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*As of 9/1/2010, our network includes 735 participating pharmacies in Arkansas.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. This is an advertisement; for more information, contact a benefits specialist.


H4213_Adv 2011 Website Submission CMS Approved 10182010

Web Page Last Updated: 8/30/2011