prescription what you pay
What you pay
| For Choice HSA, Value HSA or Choice HRA medical plan option only | For Value HRA medical plan option only | |||
|---|---|---|---|---|
| Retail pharmacy (30-day supply) | Express Scripts mail order service or Smart90 Walgreens (90-day supply) | Retail pharmacy (30-day supply) | Express Scripts mail order service or Smart90 Walgreens (90-day supply) |
|
| Medical plan deductible applies | Yes | Yes | ||
| Generic | After deducible is met, 20% up to a $20 max | After deductible is met, 20% with a $30 min up to $60 max | After deductible is met, 0% | After deductible is met, 0% |
| Preferred brand | After deductible is met, 20% with a $35 min and $100 max | After deductible is met, 20% with a $105 min and $300 max | After deductible is met, 0% | After deductible is met, 0% |
| Non-preferred brand | After deductible is met, 40% | After deductible is met, 0% | ||
| Contraceptives — generic | Covered in full | Covered in full | ||
| Preventive — generic & preferred | Covered in full | Covered in full | ||
To check how your prescriptions will be covered under the HSA and HRA Plans, visit the Express Scripts pre-enrollment website.
