Large group plans coverage

Prescription drug coverage effective on or after Jan. 1, 2019

2019 Medical Plan  Pharmacy Plan Formulary
Choice
Connect
Option Advantage A
Option Advantage B
Option Advantage AB
Out of Area
Personal Option
Traditional Option

Rx $10/$15/$30/$60/50%
2019 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 2019 Providence Formulary A
Rx $15/$45
Rx $15/50%  |  rXtra $15/50%
Value Plan Rx $5/$10/$50/50%
2019 Providence Formulary D
Rx $5/$15/$30/50%
Rx $5/$15/$40/50%
HSA HSA Qualified Plans (5-tier) 2019 Providence Formulary B
HSA Qualified Plans with Safe Harbor (5-tier) 2019 Providence Formulary F