Table Heading
| Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services | |
|---|---|
| Premium |
Please review the Annual Enrollment materials you received from Western & Southern for more information about the premium for this plan, or contact Western & Southern Financial Group’s Benefits Department at 1-800-333-1455 or 1-513-629-1400, or send an e-mail to benefits@westernsouthern.com. |
| Deductible |
Annual deductible of $75.00. There is no deductible for insulin products and most adult Part D vaccines, including shingles, tetanus and travel vaccines. |
Your share of the cost when you get a 30-day supply of a covered Part D prescription drug:
| Network Retail Pharmacy (Up to a 30-day supply available at any network pharmacy) | Long-Term Care (LTC) Pharmacy (Up to a 31-day supply) | |
|---|---|---|
| Tier 1 - Generics | $10.00 | $10.00 |
| Tier 2 - Preferred Brands | $25.00 | $25.00 |