Select Blue Advantage Series III
Prescription Drugs
|
Options |
Prescription Drug Card Program |
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|
Copayment Amounts |
Calendar Year Maximum Benefits |
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|
Generic |
Preferred |
Non Preferred |
||
|
Plan I |
$10 |
$30 |
$45 |
$3,000 |
|
Plan II |
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|
Plan III |
$10 |
$30 |
$45 |
$3,000 |
|
Plan IV |
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|
Plan V |
$10 |
$30 |
$45 |
$3,000 |
|
Plan VI |
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|
Plan VII |
$10 |
$30 |
$45 |
$3,000 |
|
Plan VIII |
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