Page 11 - 2013 ABC FCU Benefits & Notices (DEMO)

ABC FCU 2013

Important Notice from ABC Federal Credit Union (ABCFCU)
About Your Prescription Drug Coverage and Medicare

Notice of Creditable Coverage for Medicare Rx






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 




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 


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

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

ABCFCU Retail Copays (30-day supply)

BCBSM PPO 12 Plan

Generic (Tier I) Drugs Up to $10.00 copay per script
Brand Formulary (Tier II) Drugs Up to $40.00 copay per script

Brand Non-Formulary (Tier III) Drugs Up to $80.00 copay per script

ABCFCU Retail or Mail Order (90-day supply)

Generic (Tier I) Drugs Up to $20.00 copay per script

Brand Formulary (Tier II) Drugs Up to $80.00 copay per script
Brand Non-Formulary (Tier III) Drugs Up to $160.00 copay per script

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