Value |
Enhanced |
Complete |
|
|---|---|---|---|
Deductible |
$150.00 |
$0.00 |
$0.00 |
Preferred generic co-pay |
$5.00 |
$7.00 |
$7.00 |
Non-Preferred Generic/Preferred brand co-pay |
$35.00 |
$43.00 |
$45.00 |
Non-preferred co-pay |
35% |
$75.00 |
$75.00 |
Specialty drug co-pay |
N/A |
33% |
33% |
Mail order |
|
|
|
Monthly premium |
$26.90 |
$42.70 |
$105.90 |




