HCGH EPO Plan — 2023
Prescription Deductibles
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| In-Network Retail Pharmacy (30-day supply) | In-Network Retail Pharmacy (90-day supply) | Mail Order (90-day supply) | |
|---|---|---|---|
| Plan Year Deductible | |||
| Individual | $0 | $0 | $0 |
| Family | $0 | $0 | $0 |
| Out-of-Pocket Maximum | |||
| Individual | $4100 | $4100 | $4100 |
| Family | $8200 | $8200 | $8200 |
| Lifetime Maximum | |||
| Individual | Unlimited | Unlimited | Unlimited |
| Family | Unlimited | Unlimited | Unlimited |
