| Plan Name |
Prescription Benefit Plan Options |
| HSAP1500 - 20% |
- 50019 - 5 Tier $10/25/50/50/80
- 50509 - Deductible then 50% Co-insurance
|
| HSAP2000 - 20% |
- 50021 - 5 Tier $10/25/50/50/80
- 50511 - Deductible then 50% Co-insurance
|
| HSAP2500 - 20% |
- 50023 - 5 Tier $10/25/50/50/80
- 50513 - Deductible then 50% Co-insurance
|
| HSAP3000 - 20% |
- 50025 - 5 Tier $10/25/50/50/80
- 50515 - Deductible then 50% Co-insurance
|
| HSAP3500 - 20% |
- 50045 - 5 Tier $10/25/50/50/80
- 50525 - Deductible then 50% Co-insurance
|
| HSAP4000 - 20% |
- 50047 - 5 Tier $10/25/50/50/80
- 50527 - Deductible then 50% Co-insurance
|
| HSAP4500 - 20% |
- 50049 - 5 Tier $10/25/50/50/80
- 50529 - Deductible then 50% Co-insurance
|
| HSAP5000 - 20% |
- 50051 - 5 Tier $10/25/50/50/80
- 50531 - Deductible then 50% Co-insurance
|
