Prescription Drug Plans - Benefit Summaries
Non-MSGR (All Options)

The following prescription drug benefit summaries are now available for Non-MSGR (1-50 & 51-199). The information is presented in a printer-friendly, PDF format.  The information is presented in a printer-friendly, PDF format. Download Acrobat Reader Please check the site frequently for summary updates. Visit our Pharmacy home page for more information and updates.

Non-MSGR Rx: 1-50 & 51-199
Option Features Brochure Number
Option 1 $0 Ded., $0/25/45 CUT7049
Option 2 $100 Ded., $0/25/45 CUT7050
$Int Ded., $0/25/45 CUT7051
Option 3 $0 Ded; $5/10/25 CUT5686
Option 4 $0 Ded; $8/15/30 CUT5689
Option 5 $100 Ded; $8/15/30 CUT5712
Option 6 $0 Ded; $10/20/35 4,000 ABM CUT5794
Option 7 $0 Ded; $10/20/35 CUT5693
Option 8 $50 Ded; $10/20/35 CUT5695
Option 9 $100 Ded; $10/20/35 CUT5713
Option 10 $0 Ded; $10/25/45 4,000 ABM CUT6437
Option 11 $0 Ded; $10/25/45 8,000 ABM CUT6438
Option 12 $0 Ded; $10/25/45 CUT6439
Option 13 $100 Ded; $10/25/45 4,000 ABM CUT6443
Option 14 $100 Ded; $10/25/45 8,000 ABM CUT6444
Option 15 $100 Ded; $10/25/45 CUT6445
Option 16 $200 Ded; $10/25/45 4,000 ABM CUT6446
Option 17 $200 Ded; $10/25/45 8,000 ABM CUT6447
Option 18 $200 Ded; $10/25/45 CUT6448
Option 19 $0 Ded; $15/35/60 4,000 ABM CUT6425
Option 20 $0 Ded; $15/35/60 8,000 ABM CUT6426
Option 21 $0 Ded; $15/35/60
CUT6427
Option 22 $100 Ded; $15/35/60 4,000 ABM CUT6431
Option 23 $100 Ded; $15/35/60 8000 ABM CUT6432
Option 24 $100 Ded; $15/35/60
CUT6433
Option 25 $200 Ded; $15/35/60 4,000 ABM CUT6434
Option 26 $200 Ded; $15/35/60 8,000 ABM CUT6435
Option 27 $200 Ded; $15/35/60
CUT6436
Option 28 $0 Ded; 30% 4,000 ABM
CUT6449
Option 29 $0 Ded; 30%
CUT6450
Option 30 $100 Ded; 30% ABM 4,000 CUT6451
Option 31 $100 Ded; 30% CUT6452

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