Medical
Prescription Benefit Summary
Prescription Benefits Provided by:
Medco Health Solutions
Customer Service Number:(800) 336-5933
Website:www.medco.com

The table below is an outline of your prescription benefits for the PPO Medical Plan.

Prescription Drug Benefits

Feature
30-day supply
Generic Prescription Co-pay $10
Preferred Prescription Co-pay (no generic equivalent) $35
Non-preferred Prescription Co-pay (no generic equivalent $55
Brand name Prescription w/ available generic equivalent Generic prescription co-pay plus the difference between the Plan's cost of the brand name drug and the Plan's cost of the generic drug

Diabetic Testing Supplies

Preferred Brand $10
Non-Preferred Brand $25

Prescription drug copayments are limited to $2,500 per person per benefit period. After the $2,500 maximum is reached, the health benefit plan pays 100% of allowed prescription drug charges.

You can also access Medco's My Rx Choices, a tool to assist you in identifying potential cost saving alternatives for any of your prescriptions.