Large group plans coverage

Prescription drug coverage effective on or after Jan. 1, 2020

2020 Product  Prescription Drug Plan Formulary
Choice
Connect
Option Advantage Base
Option Advantage Plus (A)
Option Advantage Premium (B)
Out of Area
Personal Option
Traditional Option

Rx $10/$15/$30/$60/50%
2020 Providence Formulary B
Rx $10/$15/$45/$75/50%
Rx $10/$15/$60/$80/50%
Rx $15/$15/$30/$30/$30
Rx $15/$15/$45/$45/$45
Rx $15/$20/50%/50%/50%
Rx $15/$20/$75/$100/50%
Rx $15/$30  |  rXtra $15/$30 2020 Providence Formulary A
Rx $15/$45
Rx $15/50%  |  rXtra $15/50%
Value Plan Rx $5/$10/$50/50%
2020 Providence Formulary D
Rx $5/$15/$30/50%
Rx $5/$15/$40/50%
HSA (Aggregate & Embedded)
HSA Connect (Aggregate & Embedded)
HSA Qualified Plans (5-tier) 2020 Providence Formulary B
HSA Qualified Plans with Safe Harbor (5-tier) 2020 Providence Formulary F