Page 15 - 2020 Benefits Guide

HDHP
Standard Plan Consumer
Plan
Prescription Drug $100 per person (family limits apply) Unless
Deductible “preventive”,
applies to
deductible
Prescription Medications Up to 30-Day Supply 90-Day Supply Deductible,
Generic 25%, $15 Min., $30 Max. 0 then 20%
Brand/Formulary 40%, $35 Min., $100 Max. 30%, $40 Min., $200 Max. (Drugs on the
Brand/Non-Formulary 50%, $45 Min., $150 Max. 50%, $60 Min., $300 Max. Preventive Therapy
Insulin/Formulary 40%, $50 Copay Max. 30%, $150 Copay Max. List bypass the
Specialty RX 40%, $250 Max. N/A deductible.)

Wade Walania, Inside Sales Rep
Mankato, MN
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