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PRESCRIPTIONS Preferred Generic/Generic/ Preferred Brand
INDIVIDUAL COUNSELING + THERAPY
VIRTUAL CARE Amwell or Virtuwell
SPECIALTY CARE
PREVENTIVE CARE
40% coinsurance
$0
$0
40% coinsurance
$10/$20/$120
50% coinsurance
$0
$0
50% coinsurance
$20/$30/$200
$160 after deductible
$0
$0
$0 after deductible
$30/$30/$200
$150
$0
$0
$60
$25/$30/$150
$75
$0
$0
$0
$0/$15/$100
$120
$0
$0
$40
$25/$30/$165
0% coinsurance
$0 after deductible
$0
0% coinsurance
0% coinsurance
Silver MODERATE PREMIUMS
Bronze LOWER PREMIUMS
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