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Creditable Pharmacy Plan Designs

All Medicare-eligible employees and retirees will be eligible for a new prescription drug program. Employers are required by the Centers for Medicare and Medicaid Services (CMS) to notify their employees and retirees by November 14, about whether their existing prescription drug plan is at least as good as Medicare’s standard prescription drug program, also referred to as providing “creditable coverage.”

289 Pharmacy Plan Designs
Pharmacy Plan Designs Creditable Creditable/Non-Creditable Coverage Estimate
Copay Tiers: $.75/$.75/$.75
Deductible:N/A
Coinsurance:N/A
Annual Max:$500
Copay Tiers: $0/$0/$0
Deductible:$1500 (IND) RX & MED
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $0/$0/$0
Deductible:$2000IND(RX&Med)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $0/$0/$0
Deductible:$3000 (FAM) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $0/$0/$0
Deductible:$4000FAM(RX&MED)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $0/$15/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $0/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$10/$10
Deductible:N/A
Coinsurance:N/A
Annual Max:$1,000
No
Copay Tiers: $10/$10/$10
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$10/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:$1,000
No
Copay Tiers: $10/$10/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:$1,500
No
Copay Tiers: $10/$10/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:$2,000
No
Copay Tiers: $10/$10/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$15/$15
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$15/$25
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$15/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$15/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$20
Deductible:$100
Coinsurance:N/A
Annual Max:$3,000
Copay Tiers: $10/$20/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$30
Deductible:$1500 (IND) RX & MED
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $10/$20/$30
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $10/$20/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$35
Deductible:$100 IND/$200 FAM
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$35
Deductible:$1500 RX & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $10/$20/$35
Deductible:$3000 Rx & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $10/$20/$35
Deductible:$50/$100
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:$1,000
No
Copay Tiers: $10/$20/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:$2,000
No
Copay Tiers: $10/$20/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:$25,000 Lifetime Max
Copay Tiers: $10/$20/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:$3,000
Copay Tiers: $10/$20/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$35 DM
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
No
Copay Tiers: $10/$20/$40
Deductible:$50 IND/$100 FAM -tier 1 does not apply
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$20/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:$200/qtr; No Rollover
No
Copay Tiers: $10/$20/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$25/$25
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$25/$40
Deductible:$2500 (IND) RX & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $10/$25/$40
Deductible:$50/$100
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$25/$40
Deductible:$5000 Fam (RX & Medical)
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $10/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:$2,000
No
Copay Tiers: $10/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$25/$45
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$25/$50
Deductible:$50/$100
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$30/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$30/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$30/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$30/$50
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/$35/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $10/$35/$40
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $10/$35/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $10/50%/50%
Deductible:N/A
Coinsurance:N/A
Annual Max:$1,000 including OON
No
Copay Tiers: $10/50%/50%
Deductible:N/A
Coinsurance:N/A
Annual Max:$5,000 including OON
No
Copay Tiers: $12/$20/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $12/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $13/$13/$26
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$15/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$20/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$20/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:$1,000
No
Copay Tiers: $15/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:$2,000
No
Copay Tiers: $15/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:$3,000
Copay Tiers: $15/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:N/A
Coinsurance:$1,500
Annual Max:$3,000
No
Copay Tiers: $15/$25/$40
Deductible:$1,100 (Ind) RX& Med
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$10,000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
No
Copay Tiers: $15/$25/$40
Deductible:$10,000 (FAM) RX & Medical
Coinsurance:$3,000
Annual Max:N/A
No
Copay Tiers: $15/$25/$40
Deductible:$100 IND/$200 FAM
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$100 IND/$200 FAM-Tier 1 does not apply
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$100 ind/$300 Fam
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$100/$200
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$1250 (IND) RX & Medical
Coinsurance:IN $1,000/OON $6,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:$1,500
Annual Max:$3,000
No
Copay Tiers: $15/$25/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:$1250
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:$750
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:IN $1,000/OON $6,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$1500(IND)RX&MED INC OON
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2,200 (family)RX & Med
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$200 ind / $400 fam
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2000 (IND) RX & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2000 (IND) RX & Medical
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2000 (IND) RX & Medical
Coinsurance:$750
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2000 (IND) RX & Medical
Coinsurance:IN $1,000/OON $6,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2000 (IND) RX & Medical
Coinsurance:IN $750/OON $6000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2000IND(RX&Med)INC OON
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500 (FAM) RX & Medical
Coinsurance:$IN $2,000/OON $8,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500 (IND) RX & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500 (IND) RX & Medical
Coinsurance:$500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500 (IND) RX & Medical
Coinsurance:$750
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500 (IND) RX & Medical
Coinsurance:IN $1,000/OON $6,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500 (IND) RX & Medical
Coinsurance:IN $750/OON $6000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500 Rx & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500 Rx & Medical
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$2500(IND)RX&MED INC OON
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3,000 (IND) RX & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3,000 (IND) RX & Medical
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3,000 (IND) RX & Medical
Coinsurance:IN $1,000/OON $6,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$2500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$3,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$IN $2,000/OON $8,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000 Rx & Medical
Coinsurance:$1,500
Annual Max:$3,000
No
Copay Tiers: $15/$25/$40
Deductible:$3000 Rx & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000 Rx & Medical
Coinsurance:$3,000
Annual Max:$3,000
No
Copay Tiers: $15/$25/$40
Deductible:$3000 Rx & Medical
Coinsurance:$3,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000(FAM)RX&MED INC OON
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3000IND(RX&Med)INC OON
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3500 (IND) RX & MED
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3500 (IND) RX & MED
Coinsurance:IN $1,000/OON $6,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$3500 Rx & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$4000 (FAM) RX & Medical
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$4000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$4000 (FAM) RX & Medical
Coinsurance:$3,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$4000 (FAM) RX & Medical
Coinsurance:$IN $2,000/OON $8,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$4000 (FAM) RX & Medical
Coinsurance:IN $1500/OON $8000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$4000FAM(RX&MED)INC OON
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5,000 (IND) RX & Medical
Coinsurance:$1,000
Annual Max:N/A
No
Copay Tiers: $15/$25/$40
Deductible:$5,000 (IND) RX & Medical
Coinsurance:$1,500
Annual Max:N/A
No
Copay Tiers: $15/$25/$40
Deductible:$50 IND/ $100 FAM
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 (FAM) RX $ Medical
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 (FAM) RX $ Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 (FAM) RX $ Medical
Coinsurance:$IN $2,000/OON $8,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 Fam (RX & Medical)
Coinsurance:$1,000
Annual Max:N/A
No
Copay Tiers: $15/$25/$40
Deductible:$5000 Fam (RX & Medical)
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 Fam (RX & Medical)
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 Fam (RX & Medical)
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 Fam (RX & Medical)
Coinsurance:IN $1500/OON $8000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 Rx & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000 Rx & Medical
Coinsurance:$3,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$5000(FAM)RX&MED INC OON
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$6,000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$6,000 (FAM) RX & Medical
Coinsurance:$3,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$6,000 (FAM) RX & Medical
Coinsurance:$IN $2,000/OON $8,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$6,000 RX & Medical
Coinsurance:$3,000
Annual Max:$3,000
No
Copay Tiers: $15/$25/$40
Deductible:$6000FAM(RX&Med)INC OON
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$7000 (FAM) RX & MED
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$7000 (FAM) RX & MED
Coinsurance:$IN $2,000/OON $8,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:$7000 Rx & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:$2,000
No
Copay Tiers: $15/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$100 IND/$200 FAM
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$100 IND/$200 FAM
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$100 IND/$300 FAM-Tier 1 does not apply
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$100/$200
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$200 ind / $400 fam
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$200 ind / $400 fam
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$3500 IND (RX & Medical)
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$50 IND/ $100 FAM
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$50 IND/$100 FAM -tier 1 does not apply
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:$7000 FAM (RX & Medical)
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:$2,000
No
Copay Tiers: $15/$30/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:$800
No
Copay Tiers: $15/$30/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$50
Deductible:$250 per member
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/$50
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$30/50%
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/$35/$70
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $15/50%/50%
Deductible:$200 ind / $400 fam
Coinsurance:IND $4000/Fam $8000
Annual Max:N/A
Copay Tiers: $2/$2/$4
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $2/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $2/$5/$10
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $2/$7/$7
Deductible:N/A
Coinsurance:N/A
Annual Max:$800
Copay Tiers: $20/$20/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/$20/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/$20/$40
Deductible:$100 IND/$200 FAM
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/$20/$40
Deductible:$200 ind / $400 fam
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/$20/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/$25/$25
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$1500 (IND) RX & MED
Coinsurance:IN $1,000/OON $6,000
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$200 ind / $400 fam
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$2000 (IND) RX & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$2000 (IND) RX & Medical
Coinsurance:IN $1,000/OON $6,000
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$IN $2,000/OON $8,000
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$4000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: $20/$30/$40
Deductible:$4000 (FAM) RX & Medical
Coinsurance:$IN $2,000/OON $8,000
Annual Max:N/A
Copay Tiers: $20/$35/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $20/50%/50%
Deductible:N/A
Coinsurance:N/A
Annual Max:$3,000
No
Copay Tiers: $3/$3/$3
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $3/$3/$5
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $3/$3/$6
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $3/$5/$5
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $3/$6/$6
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$10/$10
Deductible:$100 / $300
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$10/$10
Deductible:N/A
Coinsurance:N/A
Annual Max:$2,000
Copay Tiers: $5/$10/$10
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$10/$15
Deductible:N/A
Coinsurance:N/A
Annual Max:$4,000
Copay Tiers: $5/$10/$15
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$10/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$10/$25
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$15/$20
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$15/$25
Deductible:N/A
Coinsurance:N/A
Annual Max:$2,000
Copay Tiers: $5/$15/$25
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$15/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$20/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$20/$30
Deductible:$1500 (IND) RX & MED
Coinsurance:IN $500/OON $6,000
Annual Max:N/A
Copay Tiers: $5/$20/$30
Deductible:$3000 (FAM) RX & Medical
Coinsurance:$IN $1,000/OON$8,000
Annual Max:N/A
Copay Tiers: $5/$20/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$20/$35
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$30/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$5/$10
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/$5/$5
Deductible:N/A
Coinsurance:N/A
Annual Max:$1,000
No
Copay Tiers: $5/$5/$5
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $5/100%/100%
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
No
Copay Tiers: $7/$12/$24
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $7/$15/$15
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $7/$15/$25
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $7/$15/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $7/$20/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $7/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $8/$20/$30
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: $8/$25/$40
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$10,000 (FAM) RX & Medical
Coinsurance:N/A
Annual Max:$3,000
No
Copay Tiers: 0%/0%/0%
Deductible:$10,000 (FAM) RX & Medical
Coinsurance:N/A
Annual Max:N/A
No
Copay Tiers: 0%/0%/0%
Deductible:$10,000 (FAM) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$10,000 Rx & Medical
Coinsurance:N/A
Annual Max:N/A
No
Copay Tiers: 0%/0%/0%
Deductible:$10000(FAM) RX&Med INC OON
Coinsurance:OON $20,000
Annual Max:N/A
No
Copay Tiers: 0%/0%/0%
Deductible:$1100IND(RX&MED)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$1150IND(RX&Med)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$1500 (IND) RX & MED
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$1500 RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$1500(IND)RX&MED INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$2000 (IND) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$2000IND(RX&Med)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$2200FAM(RX&MED)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$2300FAM(RX&Med)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$2500 (IND) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$2500IND(RX&MED)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$3,000 (IND) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$3000 (FAM) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$3000 Rx & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$3000(FAM)RX&MED INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$3000IND(RX&Med)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$3500 IND (RX & Medical)
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$4000 (FAM) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$4000FAM(RX&MED)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$5,000 (IND) RX & Medical
Coinsurance:N/A
Annual Max:$3,000
No
Copay Tiers: 0%/0%/0%
Deductible:$5,000 (IND) RX & Medical
Coinsurance:N/A
Annual Max:N/A
No
Copay Tiers: 0%/0%/0%
Deductible:$5,000 (IND) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$5000 (FAM) RX $ Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$5000 Fam (RX & Medical)
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$5000 Rx & Medical
Coinsurance:N/A
Annual Max:N/A
No
Copay Tiers: 0%/0%/0%
Deductible:$5000(IND)RX&Med INC OON
Coinsurance:OON $10,000
Annual Max:N/A
No
Copay Tiers: 0%/0%/0%
Deductible:$5000FAM(RX&MED)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$6,000 (FAM) RX & Medical
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$6000FAM(RX&Med)INC OON
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:$7000 FAM (RX & Medical)
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 0%/0%/0%
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
No
Copay Tiers: 0%/0%/0%
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 10%/10%/10%
Deductible:$1500 (IND) RX & MED
Coinsurance:IN $500/OON $1,000
Annual Max:N/A
Copay Tiers: 10%/10%/10%
Deductible:$2500 (IND) RX & Medical
Coinsurance:IN $500/OON $1,000
Annual Max:N/A
Copay Tiers: 10%/10%/10%
Deductible:$3000 (FAM) RX & Medical
Coinsurance:IN $1,000/OON $2,000
Annual Max:N/A
Copay Tiers: 10%/10%/10%
Deductible:$500 IND/$1000 FAM (RX&MED)
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 10%/10%/10%
Deductible:$5000 (FAM) RX $ Medical
Coinsurance:IN $1,000/OON $2,000
Annual Max:N/A
Copay Tiers: 100%/100%/100%
Deductible:N/A
Coinsurance:N/A
Annual Max:N/A
No
Copay Tiers: 20% - $10/$25/20% - $25/$50/20% - $40/$75
Deductible:$25 per person
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 20%/20%/20%
Deductible:$1500 (IND) RX & MED
Coinsurance:IN $500/OON $5000
Annual Max:N/A
Copay Tiers: 20%/20%/20%
Deductible:$2000 (IND) RX & Medical
Coinsurance:IN $500/OON $5000
Annual Max:N/A
Copay Tiers: 20%/20%/20%
Deductible:$3,000 (IND) RX & Medical
Coinsurance:IN $500/OON $5000
Annual Max:N/A
Copay Tiers: 20%/20%/20%
Deductible:$3000 (FAM) RX & Medical
Coinsurance:IN $1000/OON $10,000
Annual Max:N/A
Copay Tiers: 20%/20%/20%
Deductible:$4000 (FAM) RX & Medical
Coinsurance:IN $1000/OON $10,000
Annual Max:N/A
Copay Tiers: 20%/20%/20%
Deductible:$50/$100
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 20%/20%/20%
Deductible:$6,000 (FAM) RX & Medical
Coinsurance:IN $1000/OON $10,000
Annual Max:N/A
Copay Tiers: 20%/20%/30%
Deductible:$50/$100
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$1,100 (Ind) RX& Med
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$100/$200
Coinsurance:N/A
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$1500 RX & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$1500 RX & Medical
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$2,000 IND (RX & MEDICAL)
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$2,200 (family)RX & Med
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$2500 Rx & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$2500 Rx & Medical
Coinsurance:$1,500
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$3000 Rx & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$3000 Rx & Medical
Coinsurance:$3,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$3500 Rx & Medical
Coinsurance:$1,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$4000 (FAM) RX & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$5000 Rx & Medical
Coinsurance:$2,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$5000 Rx & Medical
Coinsurance:$3,000
Annual Max:N/A
Copay Tiers: 30%/30%/30%
Deductible:$7000 Rx & Medical
Coinsurance:$2,000
Annual Max:N/A