Common Contracts
1 similar null contracts
AGREEMENTOctober 3rd, 2019
Office Visit $25.00 co-pay Emergency Room Visit $150.00 co-pay Urgent Care Visit $75.00 co-pay HospitalizationOutpatient surgery $250.00 co-pay$250.00 co-pay Prescription Drugs 3 Tier Public Sector Managed Plan:$5/$30/$50 Co-payments:$5 for generic$30 for formulary$50 for off formulary 2x Mail OrderUnlimited Maximum
