Retail Prescriptions: Generic $10 copay 50% after deductible, Minimum $30 20% after deductible 40% after deductible 0% after deductible 30% after deductible Retail Prescriptions: Preferred $30 copay 50% after deductible, Minimum $30 20% after deductible 40% after deductible 0% after deductible 30% after deductible Retail Prescriptions: Non-Preferred $75 copay 50% after deductible, Minimum $30 20% after deductible 40% after deductible 0% after deductible 30% after deductible Retail Prescriptions: Specialty $300 copay 50% after deductible, Minimum $30 20% after deductible 40% after deductible 0% after deductible 0% after deductible Mail Order: Generic $10 copay Not covered 20% after deductible Not covered 0% after deductible Not covered Mail Order: Preferred $65 copay Not covered 20% after deductible Not covered 0% after deductible Not covered Mail Order: Non-Preferred $145 copay Not covered 20% after deductible Not covered 0% after deductible Not covered Mail Order: Specialty $300 Copay Not covered 20% after deductible Not covered 0% after deductible Not covered Surest Core HDHP IN NETWORK OUT-OF-NETWORK IN NETWORK OUT-OF-NETWORK Basic HDHP IN NETWORK OUT-OF-NETWORK