Page 19 - SOLO Member Guidebook
P. 19

50% ($200 Deductible)  $500 Coins Max per Script



              Tier 4








                 50% ($200 Deductible)  $150 Coins Max per Script



              Tier 3










                $50 ($200 Deductible)


              Tier 2












              Tier 1  $5























              PRESCRIPTION DRUG OPTION Option I – 30-Day supply through participating retail pharmacies      (Copay is 2X through mail-order)  POS DED PLANS – 2 OF 2












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