Your Pharmacy Coverage Details — At a Glance 

    No Deductible! No Plan Maximum!

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Out-Of-Pocket Maximum —

     $1,500.00

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Retail Pharmacy —

     Generic: $15.00 copay

     Brand Name: You pay 50% up to $65.00

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Mail-Order Pharmacy —

     Generic: $25.00 copay

     Brand Name: You pay 50% up to $130.00

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Smoking Cessation —

     Two treatments allowed per cycle per calendar year

     $2,000.00 Lifetime Maximum 

          Does not apply to Rx out-of-pocket maximum

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| For more information, check out the links below |

Visit Capital Rx Online

Capital Rx - Member Portal