Prescription Rx Plan
| Health Savings Plan | Traditional Plan | |||||||
|---|---|---|---|---|---|---|---|---|
| Retail Pharmacy (30 Day Supply) | ||||||||
| Medical Deductible Applies | Yes | No | ||||||
| Generic | 20% | $15 copay | ||||||
| Preferred | 20% | $50 copay | ||||||
| Non-Preferred | 20% | $80 copay | ||||||
| Preferred Specialty | Same as retail schedule above | Same as retail schedule above | ||||||
| Mail Order Pharmacy (90 Day Supply) | ||||||||
| Generic | 20% | Not covered | $30 copay | Not covered | ||||
| Preferred | 20% | Not covered | $100 copay | Not covered | ||||
| Non-Preferred | 20% | Not covered | $160 copay | Not covered | ||||
| Preferred Specialty | Dispensing Limits apply for Specialty Medications and may not qualify for mail order | Dispensing Limits Apply for Specialty Medications and may not qualify for mail order | ||||||