HMO Prescription Benefit Plan Options

 Plan Name  Prescription Benefit Plan Options
 HMO 1

 

  • 50008 - Standard 5 Tier $10/25/50/50/80
  • 50070 - Standard 5 Tier $20/40/60/60/100
  • 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 2
 HMO 3
 HMO 4
 HMO 5
 HMO 6
 HMO 7
 HMO 8