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PRESCRIPTIONS Preferred Generic/Generic/ Preferred Brand
INDIVIDUAL COUNSELING + THERAPY
VIRTUAL CARE Amwell or Virtuwell
SPECIALTY CARE
PREVENTIVE CARE
$75
$0
$0/$15/$70
$0
$0
40% coinsurance
$0
$10/$20/$115
$0
40% coinsurance
$150
$0
$25/$30/$200
$0
$80
$160 after deductible
$0
$30/$30/$200
$0
$0 after the deductible
50% coinsurance
$0
$15/$20/$200
$0
50% coinsurance
$75
$0
$0/$15/$70
$0
$0
40% coinsurance
$0
$10/$20/$115
$0
40% coinsurance
$160 after deductible
$0
$30/$30/$200
$0
$0 after deductible
50% coinsurance
$0
$15/$20/$200
$0
50% coinsurance
0% coinsurance
$0
0% coinsurance
$0
0% coinsurance
$60
$0
$15/$15/$30
$0
$30
$80
$0
$20/$20/$40
$0
$40
$150
$0
$25/$30/$200
$0
$30
Silver MODERATE PREMIUMS
Bronze LOWER PREMIUMS
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