HMO Prescription Benefit Plan Options

 Plan Name  Prescription Benefit Plan Options
 H250 COCHOICE
  • 50008 - Standard 5 Tier $10/25/50/50/80
  • 52018 - $150 Deductible then $10/25/50/50/80
  • 52028 - $250 Deductible then $10/25/50/50/80
  • 52058 - $500 Deductible then $10/25/50/50/80
  • 70000 - 50% Co-insurance
 H500 COCHOICE
 H750 COCHOICE
 H1000 COCHOICE
 H1000 EXCOCHOICE
 H1500 COCHOICE
 H2000 COCHOICE
 H2500 COCHOICE
 H3000 COCHOICE
 H3500 COCHOICE
 H4000 COCHOICE
 H4500 COCHOICE
 H5000 COCHOICE