HMO Prescription Benefit Plan Options

 Plan Name  Prescription Benefit Plan Options
 HMO $20 COPAY
  • 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
 HMO $30 COPAY