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HRA Retail Value-Based Non-Preferred Brand Name Coinsurance
80% ($60 max/Rx) Includes medication for high blood pressure, high […]
HRA Retail Value-Based Preferred Brand Name Coinsurance
90% ($50 max/Rx) Includes medication for high blood pressure, high […]
HRA Retail Value-Based Generic Copay
100% after $5 copay Includes medication for high blood pressure, […]
HRA Mail Order Non-Preferred Brand Name Coinsurance
60% ($240 max/Rx)
HRA Mail Order Preferred Brand Name Coinsurance
80% ($200 max/Rx)
HRA Mail Order Generic Copay
100% after $20 copay
HRA Retail Non-Preferred Brand Name Coinsurance
60% ($120 max/Rx)
HRA Retail Preferred Brand Name Coinsurance
80% ($100 max/Rx)