| Plan Name |
Prescription Benefit Plan Options |
| HSAH1500 - 10% |
- 50014 - 5 Tier $10/25/50/50/80
- 50200 - 5 Tier $20/40/60/60/100
- 50500 - Deductible then 50% Co-insurance
|
| HSAH2000 - 10% |
- 50012 - 5 Tier $10/25/50/50/80
- 50202 - 5 Tier $20/40/60/60/100
- 50502 - Deductible then 50% Co-insurance
|
| HSAH2500 - 10% |
- 50016 - 5 Tier $10/25/50/50/80
- 50204 - 5 Tier $20/40/60/60/100
- 50504 - Deductible then 50% Co-insurance
|
| HSAH3000 - 10% |
- 50010 - 5 Tier $10/25/50/50/80
- 50206 - 5 Tier $20/40/60/60/100
- 50506 - Deductible then 50% Co-insurance
|
