| 2018 Medical Plan |
Pharmacy Plan |
Formulary |
Canopy
Option Advantage A
Option Advantage B
Personal Option
Out of Area
Choice
Connect
Traditional Option
|
Rx $10/$15/$30/$60/50%
|
2018 Providence Formulary B
|
Rx $10/$15/$45/$75/50%
|
Rx $10/$15/$60/$80/50%
|
Rx $15/$20/$75/$100/50%
|
Rx $15/$20/50%/50%/50%
|
| Rx $15/$15/$30/$30/$30 |
| Rx $15/$15/$45/$45/$45 |
| Rx $15/$30 | rXtra $15/$30 |
2018 Providence Formulary A
|
| Rx $15/$45 |
Rx $15/50% | rXtra $15/50%
|
| Value Plan |
Rx $5/$10/$50/50%
|
2018 Providence Formulary D
|
Rx $5/$15/$30/50%
|
Rx $5/$15/$40/50%
|
| HSA |
HSA Qualified Plans (5-tier) |
2018 Providence Formulary B
|
| HSA Qualified Plans with Safe Harbor (5-tier) |
2018 Providence Formulary F
|
| HSA Qualified Plans (2-tier) |
2018 Providence Formulary A
|
HSA Qualified Plans with Safe Harbor
(2-tier) |
2018 Providence Formulary E |