$2,500 COPAY PLAN $4,000 HDHP W/ HSA Retail Prescriptions: DEDUCTIBLE, Generic $15 Then 20%, Up to Out of Pocket Maximum Retail Prescriptions: DEDUCTIBLE, Preferred $35 Then 20%, Up to Out of Pocket Maximum Retail Prescriptions: DEDUCTIBLE, Non-Preferred $55 Then 20%, Up to Out of Pocket Maximum DEDUCTIBLE, Specialty Prescriptions: 25% up to $350 Then 20%, Up to Out of Pocket Maximum Mail Order Prescriptions: DEDUCTIBLE, Generic $37.50 Then 20%, Up to Out of Pocket Maximum Mail Order Prescriptions: DEDUCTIBLE, Preferred $87.50 Then 20%, Up to Out of Pocket Maximum Mail Order Prescriptions: DEDUCTIBLE, Non-Preferred $137.50 Then 20%, Up to Out of Pocket Maximum