As of 1/1/2018, cost sharing reduction for any prescription drugs obtained by You through the use of a discount card or coupon provided by a prescription drug manufacturer, or any other form of prescription drug third party cost-sharing assistance, will not apply toward any Deductible, or the Annual Out-of-Pocket Maximum under Your Plan.
Green highlighting indicates that
no Ded applies
▲ Ded Applies. Ded is waived, except where indicated
► Min Cov: Ded is waived for the first three non-preventive office
visits for any combination of primary care, urgent care, mental health or substance
◄ Bronze: Ded is waived for the first three non-preventive office
visits for any combination of primary care, urgent care, mental health, substance
abuse, or specialist care.
‡ Outpatient Habilitation & Rehabilitation configuration note:
Member cost-share and visit limits shown apply in any place of service
§ Mail-order Rx drugs for tiers 1, 2, 3, and 5. For mail-order Rx, up to a 90-day supply is provided at twice the 30-day retail cost-sharing amount.