Option |
Copay |
Integrated Rx |
EPO $30/$50/80% 80% ER |
$30 |
|
EPO with National Access $30/$50/80% 80% ER |
$30 |
|
EPO $30/$50/80% w/$100 ER copay |
$30 |
|
EPO with National Access $30/$50/80% w/$100 ER copay |
$30 |
|
EPO $30 50% /50% |
$30 |
|
EPO with National Access $30 50%/50% |
$30 |
|
EPO $30 $50 70% |
$30 |
|
EPO with National Access $30 $50 70% |
$30 |
|
EPO $1,500 70% |
70% |
|
EPO with National Access $1,500 70% |
70% |
|
EPO HSA $1,500 70% 50% |
70% |
x |
EPO HSA $1,500 70% 50%/$125 max |
70% |
x |
EPO HSA $1,500 70% $7/50%/$125 max |
70% |
x |
EPO HSA $1,500 70% $10/$40/$60 |
70% |
x |
EPO HSA with National Access $1,500 70% 50% |
70% |
x |
EPO HSA with National Access $1,500 70% 50%/$125 max |
70% |
x |
EPO HSA with National Access $1,500 70% $7/50%/$125 max |
70% |
x |
EPO HSA with National Access $1,500 70% $10/$40/$60 M |
70% |
x |
EPO $1,250 80% |
80% |
|
EPO with National Access $1,250 80% |
80% |
|
EPO HSA $1,250 80% 50% |
80% |
x |
EPO HSA $1,250 80% 50%/$125 max |
80% |
x |
EPO HSA $1,250 80% $7/50%/$125 max |
80% |
x |
EPO HSA $1,250 80% $10/$40/$60 |
80% |
x |
EPO HSA with National Access $1,250 80% 50% |
80% |
x |
EPO HSA with National Access $1,250 80% 50%/$125 max |
80% |
x |
EPO HSA with National Access $1,250 80% $7/50%/$125 max |
80% |
x |
EPO HSA with National Access $1,250 80% $10/$40/$60 |
80% |
x |
EPO $1,250 50% |
50% |
|
EPO with National Access $1,250 50% |
50% |
|
EPO HSA $1,250 50% 50% |
50% |
x |
EPO HSA $1,250 50% 50%/$125 max |
50% |
x |
EPO HSA $1,250 50% $7/50%/$125 max |
50% |
x |
EPO HSA $1,250 50% $10/$40/$60 |
50% |
x |
EPO HSA with National Access $1,250 50% 50% |
50% |
x |
EPO HSA with National Access $1,250 50% 50%/$125 max |
50% |
x |
EPO HSA with National Access $1,250 50% $7/50%/$125 max |
50% |
x |
EPO HSA with National Access $1,250 50% $10/$40/$60 |
50% |
x |
EPO $20/$40/$250 |
$20 |
|
EPO $20/$40/$250 with National Access |
$20 |
|
EPO $30/$50/$500 |
$30 |
|
EPO with National Access $30/$50/$500 |
$30 |
|