| Option |
Copay |
Integrated Rx |
|
EPO $30/$50/80% w/INT Rx — 50%
|
$30 |
x |
|
EPO $30/$50/80% w/ Rx Card and National Access
|
$30 |
x |
|
EPO $2,500/50%
|
50% |
|
|
EPO $2,500/50% w/ National Access
|
50% |
|
|
EPO $1,500/70%
|
70% |
|
|
EPO $1,500/70% w/ National Access
|
70% |
|
|
EPO $1,250/80%
|
80% |
|
|
EPO $1,250/80% w/ National Access
|
80% |
|
|
EPO $30/50%
|
$30 |
|
|
EPO $30/50% w/ National Access
|
$30 |
|
|
EPO $2,500/50% w/INT 50% Rx w/ HSA
|
50% |
x |
|
EPO $2,500/50% w/INT $7 Rx w/ HSA
|
50% |
x |
|
EPO $2,500/50% w/INT $10 Rx w/ HSA
|
50% |
x |
|
EPO $2,500/50% w/INT 50% Rx w/ HSA and National Access
|
50% |
x |
|
EPO $2,500/50% w/INT 50%/$125 max Rx w/ HSA and National Access
|
50% |
x |
|
EPO $2,500/50% w/INT $7 Rx w/ HSA and National Access
|
50% |
x |
|
EPO $2,500/50% w/INT $10 Generic Rx w/ HSA and National Access
|
50% |
x |
|
EPO $1,500/70% w/INT 50% Rx w/ HSA
|
70% |
x |
|
EPO $1,500/70% w/INT 50%/$125 max Rx w/ HSA
|
70% |
x |
|
EPO $1,500/70% w/INT $7 Rx w/ HSA
|
70% |
x |
|
EPO $1,500/70% w/INT $10 Rx w/ HSA
|
70% |
x |
|
EPO $1,500/70% w/INT 50% Rx w/ HSA and National Access
|
70% |
x |
|
EPO $1,500/70% w/INT 50%/$125 max Rx w/ HSA and National Access
|
70% |
x |
|
EPO $1,500/70% w/INT $7 Rx w/ HSA and National Access
|
70% |
x |
|
EPO $1,500/70% w/INT $10 Generic Rx w/ HSA and National Access
|
70% |
x |
|
EPO $1,250/80% w/INT 50% Rx w/ HSA
|
80% |
x |
|
EPO $1,250/80% w/INT 50%/$125 max Rx w/ HSA
|
80% |
x |
|
EPO $1,250/80% w/INT $10 Rx w/ HSA
|
80% |
x |
|
EPO $1,250/80% w/INT 50% Rx w/ HSA and National Access
|
80% |
x |
|
EPO $1,250/80% w/INT 50%/ $125 max Rx w/ HSA and National Access
|
80% |
x |
|
EPO $1,250/80% w/INT $7 Rx w/ HSA and National Access
|
80% |
x |
|
EPO $1,250/80% w/INT $10 Generic Rx w/ HSA and National Access
|
80% |
x |
|
EPO $2,500/50% w/INT 50% Rx w/ HSA
|
50% |
x |
