SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Anderson |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Austin |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Bastrop |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Bell |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Blanco |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Bosque |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Brazos |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Burleson |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Burnet |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Cass |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Cherokee |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Coke |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Coleman |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Colorado |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Concho |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Coryell |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Crockett |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Falls |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Fayette |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Freestone |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Gregg |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Grimes |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Hamilton |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Harrison |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Henderson |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Hill |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Irion |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Kimble |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Lampasas |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Lavaca |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Lee |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Leon |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Limestone |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Llano |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Madison |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Marion |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Mason |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
McCulloch |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
McLennan |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Menard |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Milam |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Mills |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Rains |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Reagan |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Robertson |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Runnels |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Rusk |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
San Saba |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Schleicher |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Smith |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Somervell |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Sterling |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Sutton |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Tom Green |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Travis |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
-- |
|
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Van Zandt |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Waller |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Washington |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Williamson |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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SeniorCare Sr Premium - Enhanced Rx (Cost) in TX - H4564-004-0
Benefit Details
|
Wood |
$286.50 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $2.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 33%
| $3,400 Browse Formulary |
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