# text.div
BlueChoice HMO Gold $1,750

# extension[].extension[].valueCodeableConcept.coding[].display
Generic: Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month in network retail: 1 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month out of network retail: 1 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month in network retail: 3 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month out of network retail: 3 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].valueCodeableConcept.coding[].display
Zero cost-share preventative: Preventive medications and products available at no cost.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month in network retail: 1 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month out of network retail: 1 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month in network retail: 3 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month out of network retail: 3 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].valueCodeableConcept.coding[].display
Medical Service: Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month in network retail: 1 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month out of network retail: 1 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month in network retail: 3 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month out of network retail: 3 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].valueCodeableConcept.coding[].display
Generic: Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month in network retail: 1 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month out of network retail: 1 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month in network retail: 3 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month out of network retail: 3 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month in network retail: 1 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month out of network retail: 1 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month in network retail: 3 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month out of network retail: 3 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].valueCodeableConcept.coding[].display
Non-preferred Brand: Brand name drugs that cost more than ‘brand’ drugs.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month in network retail: 1 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month out of network retail: 1 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month in network retail: 3 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month out of network retail: 3 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].valueCodeableConcept.coding[].display
Specialty: Drugs used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name, and are typically the most expensive drugs on the formulary.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month in network retail: 1 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
After Deductible: The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
1 month out of network retail: 1 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month in network retail: 3 Month Supply via in-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
3 month out of network retail: 3 Month Supply via out-of-network retail pharmacy.

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).

# extension[].extension[].extension[].valueCodeableConcept.coding[].display
No Charge: No cost sharing is charged (this indicates that this benefit is not subject to the deductible).