prescription what you pay

What you pay

 For Choice HSA, Value HSA or Choice HRA medical plan option onlyFor 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 appliesYesYes
GenericAfter deducible is met, 20% up to a $20 maxAfter deductible is met, 20% with a $30 min up to $60 maxAfter deductible is met, 0%After deductible is met, 0%
Preferred brandAfter deductible is met, 20% with a $35 min and $100 maxAfter deductible is met, 20% with a $105 min and $300 maxAfter deductible is met, 0%After deductible is met, 0%
Non-preferred brandAfter deductible is met, 40%After deductible is met, 0%
Contraceptives — genericCovered in fullCovered in full
Preventive — generic & preferredCovered in fullCovered in full

 

To check how your prescriptions will be covered under the HSA and HRA Plans, visit the Express Scripts pre-enrollment website.