Forms & Documents
Summary of Benefits & Coverage
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MyWay HSA Direct Access 80/60 - $15/$35/$50 Rx (CDHRx) Plan 608
Last Updated: Oct 8, 2021
MyWay HSA Direct Access 80/60 - $15/$35/$50 Rx (CDHRx) Plan 609
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MyWay HSA Direct Access 100/70 - $15/$35/$50 Rx (CDHRx) Plan 618
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MyWay HSA Direct Access 100/70 - $15/$35/$50 Rx (CDHRx) Plan 619
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MyWay HSA Direct Access 100% - $15/$35/$50 Rx (CDHRx) Plan 620
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MyWay HSA Direct Access 100% - $15/$35/$50 Rx (CDHRx) Plan 621
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Direct Access EPO - 100% Network Only - Fixed Co-Pay $15/$25 Rx Plan 811
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Direct Access EPO - 100% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 815
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Direct Access EPO - 100% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 816
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Direct Access EPO - 100% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 817
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Direct Access EPO - 80% Network Only - Fixed Co-Pay $15/$25 Rx Plan 821
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Direct Access EPO - 80% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 825
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Direct Access EPO - 80% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 826
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Direct Access EPO - 80% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 827
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Direct Access EPO - $1500 Deductible - 80% Network Only - Fixed Co-Pay $15/$25 Rx Plan 831
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Direct Access EPO - $1500 Deductible - 80% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 835
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Direct Access EPO - $1500 Deductible - 80% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 836
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Direct Access EPO - $1500 Deductible - 80% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 837
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Direct Access EPO - $2500 Deductible - 80% Network Only - Fixed Co-Pay $15/$25 Rx Plan 841
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Direct Access EPO - $2500 Deductible - 80% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 845
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Direct Access EPO - $2500 Deductible - 80% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 846
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Direct Access EPO - $2500 Deductible - 80% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 847
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Direct Access EPO - $2500 Deductible - 100% Network Only - Fixed Co-Pay $15/$25 Rx Plan 851
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Direct Access EPO - $2500 Deductible - 100% Network Only - Co-Insurance Co-pay 70%/30% Rx Plan 855
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Summary of Benefits and Coverage - Direct Access EPO - $2500 Deductible - 100% Network Only - Fixed Co-Pay $15/$35/$50 Rx Plan 856
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Summary of Benefits and Coverage - Direct Access EPO - $2500 Deductible - 100% Network Only - Co-Insurance Co-pay 50%/50% Rx Plan 857
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Summary of Benefits and Coverage - DA EPO - 50% Network Only Plan 861 2Teir $15/$25 Rx, $2500 Deductible
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Summary of Benefits and Coverage - DA EPO - 50% Plan 865 70%/30% Rx, $2500 Deductible, Network Only
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Summary of Benefits and Coverage - DA EPO - 50% Network Only Plan 866 3Tier $15/$35/$50 Rx, $2500 Deductible
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Summary of Benefits and Coverage - DA EPO - 50% Plan 867 50% Rx, $2500 Deductible, Network Only
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Summary of Benefits and Coverage - Omnia EPO - 100/60 Plan 913 $10/$50/$75 Rx
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Summary of Benefits and Coverage - Omnia HSA EPO - 80/50 Plan 929
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Summary of Benefits and Coverage - Omnia EPO - 100/50 Plan 934
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Summary of Benefits and Coverage - Omnia HSA EPO - 90/70 Plan 949
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Summary of Benefits and Coverage - Omnia - EPO - 50% Plan 958 50% Rx
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