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Deductibles & Coinsurance Effective 7/1/24

Plan TypeDeductibleMedical Out-of Pocket Maximum (Includes Deductible)Rx Out of Pocket MaximumTotal Aggregate Out of Pocket Maximum
Individual Plan$322$1,288$6,062$7,350
Family Plan$966$3,863$10,837$14,700

Prescription Drug Co-Pays

Effective 7/1/24*

*Please note that prescription drug copayments effective 7/1/24 apply until 1/1/2025 for those enrolled in the Medicare Part D prescription drug benefit per CMS rules.

Drug CategoryDrug Co-Pay
RX Retail (1 month)*Generic - $15
Formulary - $30
Non-Formulary - $60

RX Mail Order (3 months)*Generic - $30
Formulary - $60
Non-Formulary - $95

The traditional plan does not have any medical co-payments
The Rx Out of Pocket Maximum is new effective 7/1/2015 per the Affordable Care Act.
Sample coverage examples can be found on page 7 of 8 on the Summary Benefit Comparison
The traditional plan was closed for new entrants effective 7/1/12.