Page 7 - Takoma Park Benefits Guide 2022
P. 7
Health Insurance Summary Comparison (Continued)
Out-of-Network
Deductible Aggregate N/A
Individual/Family $4,000 / $8,000
Out of Pocket
Individual/Family Separate
$9,000 / $18,000
Coinsurance
Prescription
Deductible/Person Same as Medical Same as Medical
Generic $10 $10
Preferred Brand $45 $45
Non-preferred Brand $65 $65
Specialty Drugs 50% to max $100 / $150 50% to max $100 /$150
Effective Date: 05/01/2022
