Medical
-
$12
10 Monthly Contributions
-
$100
Individual Deductible
-
$300
Family Deductible
Anthem Blue Cross
PPO Through SISC
Prescriptions
| Walk-In | ||||||
|---|---|---|---|---|---|---|
| Network | Costco | Costco | Navitus | |||
| Days’ Supply* | 30 | 90 | 30 | 90 | 90 | 30 |
| Generic | $3 | N/A | FREE | FREE | FREE | N/A |
| Brand | $15 | N/A | $15 | $35 | $35 | N/A |
| Specialty | N/A | N/A | N/A | N/A | N/A | $15 |
| Out-of-Pocket Maximum | $1,500 Individual / $2,500 Family | |||||