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Prescription Discount Plan

  YOUR PPO Plan and YOUR HSA-Eligible Plan
(after HSA deductible is met)
Retail, Generic (up to 30 days' supply) $0 copay
Retail, Preferred Brand (up to 30 days' supply) $10 off the 20% coinsurance ($25 min, $50 max)
Retail, Non-Preferred Brand (up to 30 days' supply) $10 off the 35% coinsurance ($45 min, $90 max)
Prescription Diabetic Supplies and Equipment
(pharmacy purchase)
25% off the 10% coinsurance ($15 copay maximum)