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| Oregon & Washington |
Essentials Plan |
Premier Plan |
| Mo Premium |
$32.20 |
$120.60 |
| Deductible |
$230* |
$0 |
| Tier 1 (generics) |
$0 copay |
$0 copay |
| Tier 2 (Non-preferred generic) |
$15 copay |
$10 copay |
| Tier 3 (preferred brand) |
$27 copay |
$30 copay |
| Tier 4 (Non-preferred brand) |
$67 copay |
$65 copay |
| Tier 5 (Specialty) |
25% |
33% |
| Coverage Gap** |
None |
Yes |
| Tier 1 (generics) |
n/a |
$10 copay |
| Tier 2 (Non-preferred generic) |
n/a |
$25 copay |
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| Catastrophic Coverage |
$2.40 copay |
$2.40 copay |
| after yearly costs reach $4,350 |
$6 copay or 5% |
$6 copay or 5% |
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| Mail Order (90 day supplies***) |
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| Tier 1 (generics) |
$0 copay |
$0 copay |
| Tier 2 (Non-preferred generic) |
$30 copay |
$20 copay |
| Tier 3 (preferred brand) |
$54 copay |
$60 copay |
| Tier 4 (Non-preferred brand) |
$134 copay |
$130 copay |
| Tier 5 (Specialty) |
25% |
33% |
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| * deductible applies to all drugs except Generics |
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| ** after yearly drug costs reach $2,700 you pay 100% |
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| ***applies to preferred mail order pharmacy |
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Aetna Extras:
- 40% off retail price of eyeglasses frames, savings for all types of lenses.
- 15% off Lasik procedures
- Weight Management discounts - Jenny Craig
- GlobalFit Fitness program- discounts on membership
- Discounts on over-the-counter vitamins, herbal and nutritional products
- Reduced rates from participating chiropractors, acupncturists, massage therapists, and dietetic
counselors.
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