PDF 2019 Benefits at a Glance

Office Visit Copay; RX - $75 prescription drug deductible then $12 generic, $45 preferred, $100 non-preferred, $100 specialty drug Telemedicine Services - $10 visit not subject to annual deductible on Select Plan. $49 visit until annual deductible is met then $10 on BasePlan Medical Rates (Monthly - Pre-tax): ................
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