Prescription Drugs
All four medical plans cover prescription drugs.
The cost of your prescriptions is based on:
- The tier (category) of drug prescribed; and
- How you fill your prescription (from a retail location or via home delivery).
The tiers are:
- Tier 1: Generic, lowest-cost medications
- Tier 2: Preferred brand-name low-cost medications
- Tier 3: Non-preferred brand-name medications (lower-cost options may be available)
| 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, Tier 1 | $15 copay | 80% after deductible ($15 copay max) | 70% after deductible ($15 copay max) | $15 copay | Not covered | |||
| Retail, Tier 2 | $40 copay | 80% after deductible ($40 copay max) | 70% after deductible ($40 copay max) | $40 copay | Not covered | |||
| Retail, Tier 3 | $75 copay | 80% after deductible ($75 copay max) | 70% after deductible ($75 copay max) | $75 copay | Not covered | |||
| Home Delivery, Tier 1 | $35 copay | 80% after deductible ($35 copay max) | 70% after deductible ($35 copay max) | $35 copay | Not covered | |||
| Home Delivery, Tier 2 | $100 copay | 80% after deductible ($100 copay max) | 70% after deductible ($100 copay max) | $100 copay | Not covered | |||
| Home Delivery, Tier 3 | $185 copay | 90% after deductible ($185 copay max) | 70% after deductible ($185 copay max) | $185 copay | Not covered | |||