Sheet1 SELF APWU Health Plan APWU Plan -highBCBS-BasicBCBS-StandardGEHA-highGEHA-standardGEHA-High DeductibleMailhandler-High Deductible Mailhandler-Standard Mailhandler-Value NALC-High Rural Carrier Plan
APWU Health Plan APWU Plan -highBCBS-BasicBCBS-StandardGEHA-highGEHA-standardGEHA-High DeductibleMailhandler-High Deductible Mailhandler-Standard Mailhandler-Value NALC-High Rural Carrier Plan
APWU Health Plan APWU Plan -highBCBS-BasicBCBS-StandardGEHA-highGEHA-standardGEHA-High DeductibleMailhandler-High Deductible Mailhandler-Standard Mailhandler-Value NALC-High Rural Carrier Plan
$20.98 $26.71 $23.04 $46.39 $67.70 $18.51 $23.73 $18.80 $36.07 $11.63 $32.71 $59.04
FAMILY CATA PERSON IN/OUT $47.20 3000/9000 $60.40 4000/10000 $53.95 PPO/5000 $110.72 5000/7000 $131.48 4000/6000 $42.06 5000/7000 $54.19 5000/5000 $42.61 5000/7500 $74.80 4000/9000 $27.72 4000/6000 $62.84 4000/6000 $78.81 3500/4000
CATA FAMILY IN/OUT 4500/9000 4000/10000 5000 5000/7000 4000/6000 5000/7000 10000/10000 10000/15000 4000/9000 4000/6000 4000/6000 4000/4500
CY DEDUCT IN/OUT 600/600 275/500 NONE 300/300 350/350 350/350 1500/1500 2000/2000 350/500 500/800 250/300 350/400
HOSP COPAY IN/OUT NONE/NONE NONE/300 100DAYX5 200/300+30% 100/300 NONE 5%/25% $75day/40% 200/400 NONE 100/100 100/300
ROOM/BOARD IN/OUT 15%/40%+DIF 10%/30% NONE 200/300+30% NONE 15%/35% 5%/25% 0/40% 0/30% 20%/40% 0/30% NONE
DOCTOR IN/OUT 15%/40%+DIF $18/40%+DIF $25.00 $20/30% $20/25% $10/35% 5%/25% $15/40% $20/30% $30/40% $15/25% $20/25%
RX LOCAL GEN/BRAND 25%/25% $8/25% $10/$35 20%/30% $5/25% $5/50% 25%/25% $10/$25 $10/$40 $10/50% 25%/25% 30%/30%
RX MAIL-90 GEN/BRAND 25%/25% $15/25% NA $10/$65 $15/25%/$15 $15/50% 25%/25% $20/$50/80 $15/$65/$90 $30/50% $12/$35 $10/$28
RX DEDUCT
CATA=CATASTROPHIC LIMIT IN/OUT=PPO/NON PPO OR IN NETWORK/OUT NETWORK CY DEDUCT=CALENDAR YEAR DEDUCTIBLE GEN/BRAND=GENERIC OR NON GENERIC DRUGS
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NONE NONE NONE NONE NONE NONE CY APPLIES CY APPLIES NONE NONE NONE 200