Equally Effective. Compare, shop for, and save on generic prescriptions.

PPO Benefits at a Glance

AmeriHealth Forms Online — Delaware

PDF icon Forms are in PDF format.

Option Copay
Integrated Rx
PPO 10 (In-Area) $10  
PPO 10/20/70 (In-Area) $10  
PPO 1020/80/50 (In-Area) $10  
PPO 15 (In-Area) $15  
PPO 15/25/70 (In-Area) $15  
PPO 15/25/70 (In-Area) $15  
PPO 20/30/60 (In-Area) $20  
PPO 20/30/70 (In-Area) $20  
PPO 2020/80/50 (In-Area) $20  
PPO 205 (In-Area) $5  
PPO 210 (In-Area) $10  
PPO 215 (In-Area) $15  
PPO 2520/80/50 (In-Area) $20  
PPO 310 (In-Area) $10  
PPO 5 (In-Area) $5  
PPO 5/15/70 (In-Area) $5  
PPO 520/80/50 (In-Area) $20  
HDHP HD1-HC1 $0* x  
HDHP HD1-HC1 $0*    
HDHP HD1-HC2 80%* x  
HDHP HD1-HC2 80%*    
HDHP HD2-HC1 $0* x  
HDHP HD2-HC1 $0*    
HDHP HD2-HC1 20%* x  
HDHP HD2-HC1 20%*    
HDHP HD2-HC2 20%* x  
HDHP HD2-HC2 20%*    
HDHP HD3-HC1 $0* x  
HDHP HD3-HC1 $0*    
HDHP HD3-HC2 20%* x  
HDHP HD3-HC2 20%*    
HDHP HD4-HC1 $0* x  
HDHP HD4-HC1 $0*    
HDHP HD4-HC2 20%* x  
HDHP HD4-HC2 20%*    

* after deductible