HMO Prescription Benefit Plan Options

 Plan Name  Prescription Benefit Plan Options
 HSAH1500 - 10%
  • 50014 - 5 Tier $10/25/50/50/80
  • 50500 - Deductible then 50% Co-insurance
 HSAH2000 - 10%
  • 50012 - 5 Tier $10/25/50/50/80
  • 50502 - Deductible then 50% Co-insurance
 HSAH2500 - 10%
  • 50016 - 5 Tier $10/25/50/50/80
  • 50504 - Deductible then 50% Co-insurance
 HSAH3000 - 10%
  • 50010 - 5 Tier $10/25/50/50/80
  • 50506 - Deductible then 50% Co-insurance