BlueEdgeSM Individual HSA
Prescription Drugs
|
Options |
Prescription Drug Card Program |
|||
|
Copayment Amounts |
Calendar Year Maximum Benefits |
|||
|
Generic |
Preferred |
Non Preferred |
||
|
Plan I |
$10 |
$50 |
$65 |
$5,000 |
|
Plan II |
||||
|
Plan III |
$10 |
$50 |
$65 |
$5,000 |
|
Plan IV |
||||
|
Plan V |
$10 |
$50 |
$65 |
$5,000 |
|
Plan VI |
||||
|
Plan VII |
$10 |
$50 |
$65 |
$5,000 |
