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PRESCRIPTIONS Preferred Generic/Generic/ Preferred Brand
INDIVIDUAL COUNSELING + THERAPY
VIRTUAL CARE Amwell or Virtuwell
SPECIALTY CARE
PREVENTIVE CARE
$85
$0
$0
$0
$0/$15/$80
40% coinsurance
$0
$0
40% coinsurance
$10/$20/$110
$150
$0
$0
$0
$25/$30/$200
$160 after deductible
$0
$0
$0 after deductible
$30/$30/$200
50% coinsurance
$0
$0
50% coinsurance
$15/$20/$200
Silver MODERATE PREMIUMS
Bronze LOWER PREMIUMS
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