Sibley EPO Plan — 2023
Prescription Deductibles
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In-Network Retail Pharmacy (30-day supply) | In-Network Retail Pharmacy (90-day supply) | Mail Order (90-day supply) | |
---|---|---|---|
Plan Year Deductible | |||
Individual | $0 | $0 | $0 |
Family | $0 | $0 | $0 |
Out-of-Pocket Maximum | |||
Individual | $4100 | $4100 | $4100 |
Family | $8200 | $8200 | $8200 |
Lifetime Maximum | |||
Individual | Unlimited | Unlimited | Unlimited |
Family | Unlimited | Unlimited | Unlimited |