| Prescription Drugs |
|
| Options |
Separate
Deductibles |
Prescription Drug Card Program |
| |
*Individual
(per calendar year) |
Copayment Amounts |
Calendar Year Maximum Benefits |
| Generic |
Preferred |
Non Preferred |
| Plan I |
$500 |
$10 |
$50 |
$65 |
$2,500 |
| Plan II |
$500 |
$10 |
$50 |
$65 |
$2,500 |
| Plan IIII |
| Plan IV |
$500 |
$10 |
$50 |
$65 |
$2,500 |
* Separate deductible of $500 not applicable to Generic drugs, but will be applicable to Preferred and Non-preferred drugs.
|
