Plan Feature Health Reimbursement Medical Plan Health Savings Medical Plan. Providence Pharmacies (30-day supply) Preventive: No Charge Generic: $10 copay per Rx Formulary brand: 20% of cost (maximum cost is $150 per Rx) after deductible. Non-Formulary brand: 40% of cost (maximum cost is $150 per Rx) after deductible Specialty 20% after deductible Preventive: No Charge Generic: 10% after deductible Formulary brand: 20% (maximum cost is $150 per Rx) after deductible Non-formulary brand: 40% (maximum cost is $150 per Rx) after deductible Specialty 20% after deductible
Appears in 3 contracts
Samples: Collective Bargaining Agreement, Collective Bargaining Agreement, Collective Bargaining Agreement
