Here’s What the Plan Pays
| IN NETWORK | OUT OF NETWORK | |
|---|---|---|
| Preventive Retail & Mail Order | ||
| Generic | 100% | 60% after deductible |
| Branded | 85% | 40% after deductible |
| Non-Preventive Retail & Mail Order | ||
| Generic | 85% after deductible | 60% after deductible |
| Branded | 85% after deductible | 40% after deductible |