Medical & Rx Copay Grid

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1 point

With the BH Extended Plan, for a 30-day supply Preferred Rx, using the Beaumont Pharmacy, the copay is

$125

$135

$45

$10

1 point

With the BH Network Plan, for a 30-day supply low-cost generic Rx, at a Beaumont Pharmacy, the copay is

$10

$25

$12

1 point

With the BH Network Plan, using a BHN provider, the copay at the doctor's office is

$30

$20

$40

$135

1 point

With the BH Network Plan, using an out-of-network provider , the copay at the Emergency Room is

50% after deductible

15% after deductible

$135

$55

1 point

With the BH Network Plan, for a 90-day supply low-cost generic, using BH Mail, the copay is

$12

$15

$30

1 point

With the BH Extended Plan, using a BHN provider, the copay at the specialist's office is

$40

$20

$135

$30

1 point

With the BH Savings Account Plan, using a BHN provider for a physician's office visit, the member owes

15% after deductible

40% after deductible

60% after deductible

$20.00

1 point

With the BH Network Plan, using a UHC Options PPO Provider, the copay at the Urgent Care is

$55

$40

$135

$30

1 point

With the BH Extended Plan, using a UHC Options PPO provider, the copay at the specialist's office is

$30

$45

$35

$55

10.

1 point

With the BH Extended Plan, Using a UHC Options PPO provider, the copay at the doctor's office is

$20

$30

$45

$35

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