Deductibles & Coinsurance Effective 7/1/24

Plan Type

Deductible

Medical Out-of Pocket Maximum (Includes Deductible)

Rx Out of Pocket Maximum

Total 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 Category	Drug 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.

Deductibles & Coinsurance Effective 7/1/24

Prescription Drug Co-PaysEffective 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.

Prescription Drug Co-Pays
Effective 7/1/24*