|
FIXED COPAY OPTIONS:
15/25 Copay:
Up to 30-day prescription drug supplies are available through participating retail pharmacies. Present your ID Card
along with your doctor's written prescription to the pharmacist. The pharmacist will charge you a $15.00 copayment for
each generic prescription drug purchased and a $25.00 copayment for each brand name drug purchased. Quantities up to a 90-day supply
are available through mail order service at the same applicable copayment amount.
15/35/50 Copay:
Up to 30-day prescription drug supplies are available through participating retail pharmacies. Present your ID Card
along with your doctor's written prescription to the pharmacist. The pharmacist will charge you a $15.00 copayment for
each generic prescription drug purchased; a $35.00 copayment for each preferred brand name drug purchased, and a $50.00
copayment for each non-preferred brand name drug purchased. Quantities up to a 90-day supply are available through the mail order
service at 2 times the applicable copayment amount.
COINSURANCE COPAY OPTIONS:
70/30 Coinsurance:
Up to 30-day prescription drug supplies are available through participating retail pharmacies. Present your ID Card
along with your doctor's written prescription to the pharmacist. The pharmacist will charge you 30% of the lowest
contractual price for the prescription drug (coinsurance), subject to maximum copay of $75 per prescription. The
annual Prescription Drug out-of-pocket maximum is $3,000 per person, and $6,000 per family. Quantities up to a 90-day supply are
available through mail order service at the same applicable copayment amount.
50/50 Coinsurance:
Up to 30-day prescription drug supplies are available through participating retail pharmacies. Present your ID Card
along with your doctor's written prescription to the pharmacist. The pharmacist will charge you 50% of the lowest
contractual price for the prescription drug (coinsurance), subject to maximum copay of $125 per prescription. The
annual Prescription Drug out-of-pocket maximum is $3,000 per person, and $6,000 per family. Quantities up to a 90-day supply are
available through the mail order service at 2 times the applicable copayment amount.
Unless prohibited by your physician, all plans require mandatory generic drug substitution when a generic drug is
available. Anyone using maintenance medications should take advantage of the Mail Order Prescription Service. You can
purchase up to a 90-day supply of a medication by mail. This eliminates the need to make repeated visits to the
pharmacy and provides you with additional cost and timesaving.
|
