COPAY PLAN 2000 CLEARVUE 2500 Preventive Prescriptions 100 % Covered 100 % Covered 100 % Covered Retail Prescriptions : Generic $ 20 Copay $ 15 Copay 20 % After Deductible Retail Prescriptions : Preferred $ 60 Copay $ 35 Copay 20 % After Deductible Retail Prescriptions : Non - Preferred $ 85 Copay $ 60 Copay After Deductible 20 % After Deductible Retail Prescriptions : Specialty High - Cost 20 % After Deductible 20 % After Deductible 20 % After Deductible MEDICAL PLAN OPTIONS - PHARMACY HDHP W / HSA 4000