Refer to your Outline of Coverage to determine which documents apply to your plan.

 

2012 TVHP Benefit Mandates Rider (280.317)

 

Benefit Enhancement Rider - 280.244

 

BlueCare Certificate - 280.114 (2013)

 

BlueCare Certificate - 280.114 (2011)

 

BlueCare Certificate - 280.114 (2009)
 

BlueCare Expanded Network Rider - 280.240

 

(Addition of) Deductible Carryover Rider - 280.246

 

Diabetic Prescription Drug Benefit Rider - 280.255
 

Domestic Partnership Rider - 280.121
 

Federal Mental Health Parity Rider - 280.234

 

Grandfathered Benefits Rider (TVHP) - 280.290

 

HRA BlueCare Rider w/Preventive Benefits - 280.227

 

HSA BlueCare Rider - 280.218
 

Prescription Drug Benefit Rider -280.112

 

Three-tier Prescription Drug Benefits Rider - 280.188

 

Three-tier Prescription Drug Benefit Rider A - 280.282

 

TVHP Acupuncture Benefits Rider (280.305)

 

TVHP Plan Year Accumulator Rider - 280.275

 

TVHP Prescription Drug Benefits w/Exclusions Rider - 280.280

 

TVHP Preventive Care Rider (280.304)

 

TVHP Small Group RX Rider - 280.272

 

Vision Materials Rider - 280.117

 Wellness Drug Rider - 280.279

 

Updated:  01/15/13