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JAN UARY 1, 2010 <br /> CITY OF ORONO (LOGIS) HEALTH CARE PLANS COMPARISON <br /> Open Access, Distinctions, $2500 HDHP/HRA and $2500 HDHP/HSA <br /> .. � —_ h:. . . <br /> �.� .li" - - I. It.- — ii • � '� � i � i I . 1 : i <br /> � � i - . .. � �. � � j, a <br /> ! _ � i � K�r sw :' � ��t �. j� ry � . l � 1�7� .i� . � - , ) <br /> a. �5 t � 7 7p. ��i ,- q.{ � ��i.����� { f � �' z��. {._. .!i i�i'7 <br /> � ��"N s 7" t".ffr� �..y.1�ri `� � ' �' ''� } •� � ]1 � ; ' <br /> ..Y�'r-^d�,"FS$ u*��'d'F.� ., A+, 'fs �''R � � ��r t} �'�'_ ��c � P�r�,�a -.�L.. �1� I ►."� rtl <br /> i i <br /> HeolthPartners Moi( 80%coverage with the 80%coverage with the 80 a coverage with the 100% covera;e after <br /> Order Phormocy (3 member responsible for member responsible for member responsible for deductible for atl drugs <br /> month supply) minimum payment of$20 minimum payment of minimum payment of <br /> and maximum of$50 per $20 and maximum af $20 and maximum of <br /> prescription. $50 per prescription. $50 per prescription. <br /> SPECIALTY <br /> PRESCR/PTION DRUG <br /> PROGRAM 80% coverage up to 5200 80%coverage up to 80%covera�e up to 100%covera�e after <br /> Prescription max copay per $200 max copay per $200 max copay per deductible <br /> medications on the prescription per month. prescription per month. prescription per month. <br /> specialty drug formulary <br /> This comparison is meant as a summary only and does not guarantee benefits. Ptease see your certificate of coverage for more information. <br /> 090809 3 <br />