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Once you've met the family deductible1, PharmaCare covers 70% of eligible costs until you meet the family maximum. After you meet the family maximum, PharmaCare covers 100% of eligible costs.
A printable version of this table (PDF) is also available.
Family Net Income | Family Deductible | Family Maximum | |
---|---|---|---|
$0.00 – $1,875.00 | $0.00 | $0.00 | |
$1,875.01 – $3,125.00 | $0.00 | $0.00 | |
$3,125.01 – $4,375.00 | $0.00 | $0.00 | |
$4,375.01 – $6,250.00 | $0.00 | $0.00 | |
$6,250.01 – $8,750.00 | $0.00 | $0.00 | |
$8750.01 – $11,250.00 | $0.00 | $0.00 | |
$11,250.01 – $13,750.00 | $0.00 | $0.00 | |
$13,750.01 – $15,000.00 | $0.00 | $100.00 | |
$15,000.01 – $16,250.00 | $0.00 | $200.00 | |
$16,250.01 – $18,750.00 | $0.00 | $300.00 | |
$18,750.01 – $21,250.00 | $0.00 | $400.00 | |
$21,250.01 – $23,750.00 | $0.00 | $500.00 | |
$23,750.01 – $26,250.00 | $0.00 | $600.00 | |
$26,250.01 – $28,750.00 | $0.00 | $700.00 | |
$28,750.01 – $30,000.00 | $0.00 | $800.00 | |
$30,000.01 – $31,667.00 | $650.00 | $900.00 | |
$31,667.01 – $35,000.00 | $800.00 | $1,150.00 | |
$35,000.01 – $38,333.00 | $950.00 | $1,350.00 | |
$38,333.01 – $41,667.00 | $1,100.00 | $1,500.00 | |
$41,667.01 – $45,000.00 | $1,300.00 | $1,700.00 | |
$45,000.01 – $48,333.00 | $1,400.00 | $1,875.00 | |
$48,333.01 – $51,667.00 | $1,500.00 | $2,000.00 | |
$51,667.01 – $55,000.00 | $1,600.00 | $2,150.00 | |
$55,000.01 – $58,333.00 | $1,700.00 | $2,275.00 | |
$58,333.01 – $61,667.00 | $1,800.00 | $2,400.00 | |
$61,667.01 – $65,000.00 | $1,900.00 | $2,550.00 | |
$65,000.01 – $70,833.00 | $2,000.00 | $2,675.00 | |
$70,833.01 – $79,167.00 | $2,250.00 | $3,000.00 | |
$79,167.01 – $87,500.00 | $2,500.00 | $3,350.00 | |
$87,500.01 – $95,833.00 | $2,750.00 | $3,675.00 | |
$95,833.01 – $108,333.00 | $3,000.00 | $4,000.00 | |
$108,333.01 – $125,000.00 | $3,500.00 | $4,675.00 | |
$125,000.01 – $141,667.00 | $4,000.00 | $5,350.00 | |
$141,667.01 – $158,333.00 | $4,500.00 | $6,000.00 | |
$158,333.01 – $183,333.00 | $5,000.00 | $6,675.00 | |
$183,333.01 – $216,667.00 | $6,000.00 | $8,000.00 | |
$216,667.01 – $250,000.00 | $7,000.00 | $9,350.00 | |
$250,000.01 – $283,333.00 | $8,000.00 | $10,000.00 | |
$283,333.01 – $316,667.00 | $9,000.00 | $10,000.00 | |
$316,667.01 – $999,999,999.00 | $10,000.00 | $10,000.00 |
Once you've met the family deductible1, PharmaCare covers 75% of eligible costs until you meet the family maximum. After you meet the family maximum, PharmaCare covers 100% of eligible costs.
A printable version of this table (PDF) is also available.
Family Net Income | Family Deductible | Family Maximum | |
---|---|---|---|
$0.00 – $3,000.00 | $0.00 | $0.00 | |
$3,000.01 – $5,000.00 | $0.00 | $0.00 | |
$5,000.01 – $7,000.00 | $0.00 | $0.00 | |
$7,000.01 – $10,000.00 | $0.00 | $0.00 | |
$10,000.01 – $14,000.00 | $0.00 | $0.00 | |
$14,000.01 – $18,000.00 | $0.00 | $200.00 | |
$18,000.01 – $22,000.00 | $0.00 | $250.00 | |
$22,000.01 – $26,000.00 | $0.00 | $300.00 | |
$26,000.01 – $30,000.00 | $0.00 | $350.00 | |
$30,000.01 – $33,000.00 | $0.00 | $400.00 | |
$33,000.01 – $37,500.00 | $350.00 | $700.00 | |
$37,500.01 – $42,500.00 | $400.00 | $800.00 | |
$42,500.01 – $47,500.00 | $450.00 | $900.00 | |
$47,500.01 – $50,000.00 | $500.00 | $1,000.00 | |
$50,000.01 – $52,500.00 | $1,000.00 | $1,500.00 | |
$52,500.01 – $57,500.00 | $1,100.00 | $1,650.00 | |
$57,500.01 – $62,500.00 | $1,200.00 | $1,800.00 | |
$62,500.01 – $67,500.00 | $1,300.00 | $1,950.00 | |
$67,500.01 – $72,500.00 | $1,400.00 | $2,100.00 | |
$72,500.01 – $77,500.00 | $1,500.00 | $2,250.00 | |
$77,500.01 – $82,500.00 | $1,600.00 | $2,400.00 | |
$82,500.01 – $87,500.00 | $1,700.00 | $2,550.00 | |
$87,500.01 – $92,500.00 | $1,800.00 | $2,700.00 | |
$92,500.01 – $97,500.00 | $1,900.00 | $2,850.00 | |
$97,500.01 – $106,250.00 | $2,000.00 | $3,000.00 | |
$106,250.01 – $118,750.00 | $2,250.00 | $3,375.00 | |
$118,750.01 – $131,250.00 | $2,500.00 | $3,750.00 | |
$131,250.01 – $143,750.00 | $2,750.00 | $4,125.00 | |
$143,750.01 – $162,500.00 | $3,000.00 | $4,500.00 | |
$162,500.01 – $187,500.00 | $3,500.00 | $5,250.00 | |
$187,500.01 – $212,500.00 | $4,000.00 | $6,000.00 | |
$212,500.01 – $237,500.00 | $4,500.00 | $6,750.00 | |
$237,500.01 – $275,000.00 | $5,000.00 | $7,500.00 | |
$275,000.01 – $325,000.00 | $6,000.00 | $9,000.00 | |
$325,000.01 – $375,000.00 | $7,000.00 | $10,000.00 | |
$375,000.01 – $425,000.00 | $8,000.00 | $10,000.00 | |
$425,000.01 – $475,000.00 | $9,000.00 | $10,000.00 | |
$475,000.01 – $999,999,999.00 | $10,000.00 | $10,000.00 |
1Note: The default family deductible is $10,000 for:
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