NRECA's Enhanced Plan
Instead of a flat dollar copayment, you pay a 25% coinsurance for your covered prescription drugs. There is no deductible, no coverage gap and no coinsurance for catastrophic coverage. The maximum you will pay in 2012 is $4,700 in true out-of-pocket costs (TrOOP).
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In addition to paying the monthly premium, you pay these costs each year when using the benefit: |
You Pay |
Plan Pays |
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1. You pay 25% of the drug cost—your coinsurance—for covered drugs. |
25% |
75% |
2.Once you reach $2,930 in total drug costs:
- For brand-name drugs, you pay 50 percent of your 25% coinsurance and you receive manufacturer discounts for the other 50% of your coinsurance.
For generic drugs, you pay your 25% coinsurance |
Brand-name drugs:
12.5% plus 12.5% in discounts
Generic drugs:
25%
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Brand-name drugs:
75%
Generic drugs:
75% |
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After you reach $4,700 in true out-of-pocket costs, including any amounts you paid and any manufacturer discounts you received, you are eligible for catastrophic coverage. |
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3. You pay nothing for covered drugs once you reach catastrophic coverage. |
0% |
100% |