| PPO Plan | HDHP #1 | HDHP #2 | | In-Network | In-Network | In-Network | | Generic (Retail) | $35 | $35 after deductible | Ded. + Coins. | | Preferred (Retail) | $65 | $65 after deductible | Ded. + Coins. | | Non-Preferred (Retail) | $100 | $100 after deductible | Ded. + Coins. | | Specialty Medications (Retail) | $200 | $200 after deductible | Ded. + Coins. | | Generic (Mail-order) | $70 | $70 after deductible | Ded. + Coins. | | Preferred (Mail-order) | $130 | $130 after deductible | Ded. + Coins. | | Non-Preferred (Mail-order) | $200 | $200 after deductible | Ded. + Coins. | | Specialty Medications (Mail-order) | $400 | $400 after deductible | Ded. + Coins. |