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2025 Medicare Advantage Plans

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Welcome

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Agenda

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2025 Braven Health

Medicare Advantage Plans

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Extra Benefits and Savings

After the presentation, a Braven Health representative will be available to help you.

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Our 2025 Medicare Advantage Plans

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Who is eligible?

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You must have Medicare

Part A and Part B.

You must reside in the service area for the

Braven Health Medicare Advantage plan you wish to enroll in.

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Large PPO Network

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Providers Nationwide

Hospitals

*Based on physician data as of 8/14/24 and is subject to change. National Medicare Advantage PPO network coverage current as of 8/14/24.

States Included in our National PPO Network

5,800*

940,000*

48*

See the doctors you want.

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Braven Medicare Choice (PPO)

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Plans are available in the following counties:

Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Monmouth, Middlesex, Ocean, Passaic, Salem and Union

Braven Medicare Choice (PPO)

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Braven Medicare Choice (PPO)

  • $0 copay for online doctor/therapist visits (telehealth) through Braven Health’s Care Online program (using Amwell only)

  • $0 copay for in-network primary care physician (PCP) visits

  • $0 copay for in-network annual physical exam

  • $0 copay for in-network routine dental, hearing and vision exams, plus expanded dental coverage

  • Rx copays starting at $0 and a $0 Rx deductible for commonly used generics

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Monthly

Premium

$0

Medical Deductible

+

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Braven Medicare Choice (PPO)

  • No referrals required
  • Nationwide network access to doctors and hospitals
  • $200 eyewear allowance for frames or contact lenses every year
  • Braven Health Smart Card loaded with extras:
  • Flex Benefit allowance
  • Fitness Benefit allowance
  • Quarterly Over-the-Counter (OTC) allowance
  • Healthy Journey Rewards
  • Quarterly grocery allowance* for eligible members
  • Additional extras like in-home support services and meal delivery after a qualified hospital stay

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* The benefits mentioned are a part of a special supplemental program for the chronically ill. Not all members qualify. To be considered for these benefits, they must meet the CMS definition of chronically ill and have been diagnosed with one or more of these chronic conditions: diabetes, chronic heart failure (CHF), cardiovascular disorders, chronic obstructive pulmonary disease (COPD). Other eligibility and coverage criteria apply.

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Braven Medicare Choice (PPO) | Medical

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Plan Coverage

In-Network

Out-of-Network

Monthly Premium

$0

Annual Deductible

$0

PCP Visit

$0 copay

$10 copay

Specialist Visit

$30 copay

$40 copay

Annual Physical Exam

$0 copay

$10 copay

Annual Routine Hearing Exam

$0 copay

$40 copay

Annual Routine Eye Exam

$0 copay

50% coinsurance

Routine Dental*

$0

Expanded Dental*

50% coinsurance

up to $1,000 max coverage per year

Telehealth (through Braven Health’s Care Online program)

$0

Inpatient Hospital

$390 copay (per day) days 1-5

$0 copay (per day) days 6+

Worldwide Emergency and Urgent Care

$110 copay

Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic and Union counties

*You may pay more if you use OON dental providers.

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Braven Medicare Choice (PPO) | Prescription

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Deductible

$200 (Tiers 3, 4, 5 only)

Level

Standard Retail �(30-day)

Preferred Mail Order

(90-day)

Standard Mail Order

(90-day)

Tier 1: Preferred Generic

$0 copay

$0 copay

$0 copay

Tier 2: Generic

$10 copay

$15 copay

$30 copay

Tier 3: Preferred Brand

$47 copay

$141 copay

$141 copay

Tier 4: Non-Preferred Drug

$100 copay

$300 copay

$300 copay

Tier 5: Specialty Tier

30% coinsurance 

Not Available

Not Available

Tier 6: Select Care Drugs

(includes generic drugs that support

conditions related to diabetes,

hypertension, osteoporosis and

high cholesterol)

$0 copay

$0 copay

$0 copay

**Coverage Gap has been eliminated for 2025. Once your out-of-pocket costs for covered Part D

prescriptions reach $2,000, you’ll pay $0 for all covered prescriptions for the rest of the year**

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Braven Medicare Choice (PPO)

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Plans are available in the following counties:

All 21 counties in New Jersey!

Braven Medicare Freedom (PPO)

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Braven Medicare Freedom (PPO)

  • Low monthly premium

  • $0 copay for online doctor/therapist visits (telehealth) through Braven Health’s Care Online program (using Amwell only)

  • $0 copay for in-network annual physical exam

  • $0 copay for in-network routine dental, hearing and vision exams, plus expanded dental coverage

  • Rx copays starting at $0 and a $0 Rx deductible for commonly used generics

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In-network

Primary Care

Physician

(PCP) Visits

$0

Medical Deductible

+

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Braven Medicare Freedom (PPO)

  • $30 monthly premium (lower if you get Extra Help or PAAD)
  • No referrals required
  • Nationwide network access to doctors and hospitals
  • $200 eyewear allowance for frames or contact lenses every year
  • Braven Health Smart Card loaded with extras:
  • Flex Benefit allowance
  • Fitness Benefit allowance
  • Quarterly Over-the-Counter (OTC) allowance
  • Healthy Journey Rewards
  • Quarterly grocery allowance* for eligible members

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* The benefits mentioned are a part of a special supplemental program for the chronically ill. Not all members qualify. To be considered for these benefits, they must meet the CMS definition of chronically ill and have been diagnosed with one or more of these chronic conditions: diabetes, chronic heart failure (CHF), cardiovascular disorders, chronic obstructive pulmonary disease (COPD). Other eligibility and coverage criteria apply.

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Braven Medicare Freedom (PPO) | Medical

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Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic and Union counties

*You may pay more if you use OON dental providers.

Plan Coverage

In-Network

Out-of-Network

Monthly Premium

$30

Annual Deductible

$0

PCP Visit

$0 copay

30% coinsurance

Specialist Visit

$20 copay

30% coinsurance

Annual Physical Exam

$0 copay

30% coinsurance

Annual Routine Hearing Exam

$0 copay

30% coinsurance

Annual Routine Eye Exam

$0 copay

50% coinsurance

Routine Dental*

$0

Expanded Dental*

50% coinsurance

up to $1,000 max coverage

Telehealth (through Braven Health’s Care Online program)

$0

Inpatient Hospital

$350 copay (per day) days 1-5, $0 copay (per day) days 6+

30% coinsurance

Worldwide Emergency and Urgent Care

$110 copay

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Braven Medicare Freedom (PPO) | Prescription

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Deductible

$200 (Tiers 3, 4, 5 only)

Level

Standard Retail �(30-day)

Preferred Mail Order

(90-day)

Standard Mail Order

(90-day)

Tier 1: Preferred Generic

$0 copay

$0 copay

$0 copay

Tier 2: Generic

$8 copay

$12 copay

$24 copay

Tier 3: Preferred Brand

$47 copay

$141 copay

$141 copay

Tier 4: Non-Preferred Drug

$100 copay

$300 copay

$300 copay

Tier 5: Specialty Tier

30% coinsurance 

Not Available

Not Available

Tier 6: Select Care Drugs

(includes generic drugs that support

conditions related to diabetes,

hypertension, osteoporosis and

high cholesterol)

$0 copay

$0 copay

$0 copay

**Coverage Gap has been eliminated for 2025. Once your out-of-pocket costs for covered Part D

prescriptions reach $2,000, you’ll pay $0 for all covered prescriptions for the rest of the year**

Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic and Union counties

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Braven Health Prescription Drug Coverage

  • Effective January 1, 2025, there will no longer be a coverage gap (donut hole) phase for part D prescription drug coverage
  • Out of pocket drug costs will be capped at $2,000
  • Once this amount is met, members will pay $0 for covered prescription drugs

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Part D Prescription Drug Coverage

Supplemental Prescription Drug Coverage

  • We cover certain prescription drugs that are not usually covered under the Medicare Part D program; including cough suppressant, prescription Vitamin D and erectile dysfunction (ED) medicine
  • Covered at the Tier 2 cost share

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Prescription Delivery

  • Get your prescriptions, over-the-counter medications and vitamins packaged, according to your doctor’s instruction, into individual packets by the times of day you take them

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Amazon Pharmacy

Walgreens Mail Service

  • Get up to a 90-day supply delivered right to you, anywhere in the United States from AllianceRx Walgreens Pharmacy 

Express Scripts® Pharmacy

  • Safe, accurate prescriptions delivered to your door
  • Free standard delivery in weather-proof packaging

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More Benefit Highlights

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Annual Physical Exam & Annual Wellness Visit

  • Detailed medical/family history
  • Head to toe assessment
  • One visit each year

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$0

Copay

for in-network Annual Physical Exam

& Annual Wellness Visit

Annual Physical Exam includes:

Annual Wellness Visit includes:

  • Routine measurements
  • Personalized prevention plan
  • One visit per calendar year

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Dental Benefits

  • Three oral exams per year
  • Three cleanings per year
  • One fluoride treatment every six months
  • One full mouth X-ray every three years
  • Bitewing X-rays (set of 4) once every six months

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$0

Copay

for in-network routine

dental services

Covered benefits include:

*Members will pay more when they see out-of-network dentists

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Expanded Dental Coverage

  • 50% coinsurance
  • Up to a $1,000 annual limit every year for covered services like fillings, simple and non-impacted extractions and gum care

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Expanded dental coverage includes:

*Excludes crowns, onlays, prosthodontics, implants, orthodontia, other �oral/maxillofacial surgery, dentures, inlays, sealants, space maintainers and missing teeth. Coverage max does not apply to Preventive and Diagnostic services.

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Hearing Benefits

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Covered benefits include:

$0 copay

In-network routine hearing exam and hearing aid evaluation/fitting

In-network Prescription Hearing Aid

$299 copay for level 1 aid (Value technology)

$599 copay for level 2 aid (Advanced technology)

$1,199 copay for level 3 aid (Premium technology)

Out-of-network Hearing Aid

Members are responsible for 100% of the charges for a hearing aid purchased outside of the HearUSA network

Members must coordinate with HearUSA for the above benefits.

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Vision Benefits

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Covered benefits include:

$0 copay*

For basic lenses and routine annual eye exam

$0 copay

For eyeglasses or contacts after cataract surgery

Annual Eyewear Allowance

In- or out-of-network for frames or contact lenses not associated with cataract surgery

*In-network through Davis Vision

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Extra Benefits �& Savings

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Braven Health Smart Card

What’s included:

  • Over-the-Counter (OTC) Allowance
  • Flex Benefit Allowance
  • Fitness Benefit Allowance
  • Healthy Journey Rewards
  • Grocery Allowance* for eligible members with qualifying chronic conditions

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Braven Health Smart Card

A flexible way to use your extra benefits!

* The benefits mentioned are a part of a special supplemental program for the chronically ill. Not all members qualify. To be considered for these benefits, they must meet the CMS definition of chronically ill and have been diagnosed with one or more of these chronic conditions: diabetes, chronic heart failure (CHF), cardiovascular disorders, chronic obstructive pulmonary disease (COPD). Other eligibility and coverage criteria apply.

Members must use participating retailers to access their Smart Card benefits

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Over-the-Counter Benefit Allowance

  • $70 quarterly allowance – Braven Medicare Choice (PPO)
  • $85 quarterly allowance - Braven Medicare Freedom (PPO)

    • Allowance will be automatically loaded onto your Braven Health Smart Card at the beginning of each calendar quarter (January, April, July & October)

    • You can use it to purchase eligible personal health items at participating retailers or online at BravenSmartCard.com

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Quarterly OTC Allowance

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Flex Benefit Allowance

  • Health-related Uber or Lyft transportation to doctor's appointments and pharmacies
  • Additional hours for in-home support services with Papa
  • WW® (Weight Watchers)
  • Acupuncture from participating locations
  • Nutritional counseling from participating locations
  • Bathroom safety devices (through online catalog only at BravenSmartCard.com)

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Receive a $275 annual allowance to use for any combination of the following items:

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Fitness Benefit Allowance

  • Gym or health club membership from participating locations (also includes fitness classes)
  • Home fitness (virtual fitness programs) from participating retailers 
  • Fitness equipment (hand-held free weights, exercise bands, yoga mat and more) from the Fitness Benefit catalog at BravenSmartCard.com or from participating retailers
  • Activity tracker (only covered when ordered from the online catalog at BravenSmartCard.com)

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Receive a $300 annual allowance towards:

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Healthy Journey Rewards Program

Earn up to $375/year in healthy rewards for completing routine health screenings or trainings such as:

  • Annual Wellness Visit
  • Colorectal Cancer Screening
  • Diabetic Retinal Eye Exam
  • Diabetic HbA1c Test
  • Diabetic Kidney Function Test
  • Diabetic Self-Management Training
  • Healthy Heart Self-Management Training
  • Breast Cancer Screening
  • Bone Mass Density Screening

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Healthy Journey Rewards

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Grocery Allowance

  • $85/quarter allowance - Braven Medicare Choice (PPO)
  • $90/quarter allowance - Braven Medicare Choice Freedom (PPO)
    • To use on eligible grocery items (food and produce) at participating retailers or online at BravenSmartCard.com
  • For eligible members with any of the following qualifying chronic illnesses: cardiovascular disorders, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes

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* The benefits mentioned are a part of a special supplemental program for the chronically ill. Not all members qualify. To be considered for these benefits, they must meet the CMS definition of chronically ill and have been diagnosed with one or more of these chronic conditions: diabetes, chronic heart failure (CHF), cardiovascular disorders, chronic obstructive pulmonary disease (COPD). Other eligibility and coverage criteria apply.

Grocery Allowance*

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In-Home Support Services

$0 copay for up to 36 hours per year

  • Services can be offered in a member’s home and can include:
    • Transportation for grocery shopping, medication pick up, and doctor's appointments
    • Technical guidance, light house help, light exercise and more
  • Additional hours can be purchased using the Flex Benefit allowance

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In-Home Support Services with Papa

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Home Delivered Meals

  • After any inpatient stay, you may be eligible to receive up to 28 nutritious meals* to help you recover from your illness 
  • Covers delivery of nutritiously balanced meals specifically for you

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No-cost Meal Delivery Benefit

*Must use contracted vendor. Unlimited occurrences per year. Available based on eligibility.

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Telehealth/24-Hour Nurse Line

Unlimited online doctor and therapist visits using your phone, tablet or computer – all for $0 with Braven Health’s Care Online Program (only through AmWell)

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Telehealth Benefit

24-Hour Nurse Line

  • Immediate answers to your health questions anytime, from anywhere – 24 hours a day
  • Access to caring, registered nurses who have an average of 15 years of clinical experience

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Braven Health App

Access plan information anytime, anywhere with the Braven Health App

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Members can:

  • View, print or download their member ID card to their digital wallet, or request a new one
  • Find a doctor, dentist or other health care provider
  • View their Explanation of Benefits (EOB)
  • See what’s covered under their plan
  • Pay their premium, and more!

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Braven Medicare Salute (PPO)

Works together with TRICARE or VA coverage

  • Braven Medicare Salute plans will be available beginning January 1, 2025. These plans were developed with NJ military veterans’ needs in mind*.
  • Members’ military healthcare coverage won’t change. Instead, Braven Medicare Salute plans add coverage that enhances and expands on military benefits.

Extra Benefits

  • A Medicare Part B Giveback Benefit, saving members $600/year ($50 per month) on their Medicare Part B premium.
  • Dental, vision, and hearing coverage.
  • A Braven Health Smart Card, loaded with extra money to use for a fitness membership, eligible OTC items, and more.
  • Access to over 70,000 local providers and access to every hospital in New Jersey**. Members have out-of-network benefits to see any provider who accepts Medicare, across the state and nationwide.

Braven Medicare Salute (PPO) plans do not include prescription drug coverage.

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A Medicare Advantage plan with Veterans’ needs in mind

*Any individual eligible for Medicare Part A and Part B and who lives in the service area may enroll into a Braven Medicare Salute (PPO) plan.

**Based on data as of 09/01/2024. Some doctors and hospitals covered through out-of-network benefits.

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Questions?

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Thank you

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Disclaimers

The Braven Health App is free. Rates from your wireless provider may apply. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Other Providers are available in our network. Prime Therapeutics is an independent company that supports Braven Health in the administration of its Part D Prescription Drug program. Prime Therapeutics has an ownership interest in Walgreens Mail Service, a central specialty and home delivery pharmacy. Amazon Pharmacy is an independent company that supports Braven Health in prescription delivery services. Amazon Pharmacy is independent from and not affiliated with Braven Health. Express Scripts® Pharmacy is a pharmacy that is contracted to provide mail pharmacy services to members of Braven Health. Express Scripts® Pharmacy is a trademark of Express Scripts Strategic Development, Inc. Davis Vision, HearUSA, and Papa are independent companies that support Braven Health in administering ancillary benefits. The Braven Health Mastercard® Prepaid Card is issued by Stride Bank, N.A. Member FDIC, pursuant to a license by Mastercard International. Stride Bank is an independent company offering debit card services and is solely responsible for its products. All trademarks, logos and brand names are the property of their respective owners. All company, product and service names used in this document are for identification purposes only. Use of these names, trademarks and brands does not imply endorsement..

Braven Health complies with applicable Federal civil rights laws and does not discriminate against, nor does it exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy, gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit determinations.

Spanish (Español): Para ayuda en español, llame al 1-833-272-8360 (TTY 711).

Chinese (中文): 如需中文協助❜請致電 1-833-272-8360 (TTY 711).

Braven Health has a Medicare contract to offer PPO plans. Enrollment in Braven Health depends on contract renewal. Products are provided by Braven Health, an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Braven Health℠ name and symbols are service marks of Braven Health. © 2024 Braven Health. Three Penn Plaza East, Newark, New Jersey 07105.

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