Prescription Drugs
All four medical plans cover prescription drugs. The cost of your prescriptions is based on:
- The type of drug prescribed (generic, preferred or non-preferred); and
- How you fill your prescription (from a retail location or via home delivery).
| Drug Type | PPO 1500 / 3000 | PPO HSA 2250 / 4500 | EPO HSA 4000 / 8000 | Surest Zero-Deductible plan |
||||
|---|---|---|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of- Network |
|
| Copay Amounts = Amounts You Pay, and % = What the Plan Pays | ||||||||
| Deductible Does Not Apply to Eligible Preventive Drugs | ||||||||
| Retail — Many generic drugs, select highest value brand drugs | $15 copay | 90% after deductible ($15 copay max) | 70% after deductible ($15 copay max) | $15 copay | Not covered | |||
| Retail — Lower value generic drugs and high-value brand drugs | $40 copay | 90% after deductible ($40 copay max) | 70% after deductible ($40 copay max) | $40 copay | Not covered | |||
| Retail — Limited number of lower value drugs and high-value specialty drugs | $75 copay | 90% after deductible ($75 copay max) | 70% after deductible ($75 copay max) | $75 copay | Not covered | |||
| Retail — Lowest value drugs and highest cost specialty drugs | $110 copay | 90% after deductible ($110 copay max) | 70% after deductible ($110 copay max) | $110 copay | Not covered | |||
| Home Delivery — Many generic drugs, select highest value brand drugs | $35 copay | 90% after deductible ($35 copay max) | 70% after deductible ($35 copay max) | $35 copay | Not covered | |||
| Home Delivery — Lower value generic drugs and high-value brand drugs | $100 copay | 90% after deductible ($100 copay max) | 70% after deductible ($100 copay max) | $100 copay | Not covered | |||
| Home Delivery — Limited number of lower value drugs and high-value specialty drugs | $185 copay | 90% after deductible ($185 copay max) | 70% after deductible ($185 copay max) | $185 copay | Not covered | |||
| Home Delivery — Lowest value drugs and highest cost specialty drugs | $275 copay | 90% after deductible ($275 copay max) | 70% after deductible ($275 copay max) | $275 copay | Not covered | |||