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Mutual of Omaha Rx Premier (PDP)

Mutual of Omaha Rx Premier (PDP) S7126-076 Plan Details
2 out of 5 stars

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-076.

$74.90
Monthly Premium

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-076.

Mutual of Omaha Rx Premier (PDP) S7126-076 Plan Details
2 out of 5 stars

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-076.

$74.90
Monthly Premium

Virginia Counties Served

Accomack Albemarle Alleghany Amelia Amherst Arlington Bland Botetourt Buchanan Chesterfield Covington City Hampton City Isle Of Wight Alexandria City Appomattox Augusta Bath Bedford Bristol City Brunswick Buckingham Buena Vista City Campbell Caroline Carroll Charles City Charlottesville City Chesapeake City Clarke Colonial Heights City Craig Culpeper Cumberland Danville City Dickenson Dinwiddie Emporia City Essex Fairfax Fairfax City Falls Church City Fauquier Floyd Fluvanna Franklin Franklin City Frederick Fredericksburg City Galax City Giles Gloucester Goochland Grayson Greene Greensville Halifax Hanover Harrisonburg City Henrico Henry Highland Hopewell City James City Jefferson King And Queen King George King William Lancaster Lee Lexington City Loudoun Louisa Lunenburg Lynchburg City Madison Manassas City Manassas Park City Martinsville City Mathews Mecklenburg Middlesex Montgomery Nelson New Kent Newport News City Norfolk City Northampton Northumberland Norton City Nottoway Orange Page Patrick Petersburg City Pittsylvania Poquoson City Portsmouth City Powhatan Prince Edward Prince George Prince William Pulaski Radford Rappahannock Richmond Richmond City Roanoke Roanoke City Rockbridge Rockingham Russell Salem Scott Shenandoah Smyth Southampton Spotsylvania Stafford Staunton City Suffolk City Surry Sussex Tazewell Virginia Beach City Warren Washington Waynesboro City Westmoreland Williamsburg City Winchester City Wise Wythe York

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $505
Out of Pocket Max In-Network: $-1
Out-of-Network: N/A
Initial Coverage Limit $4660
Catastrophic Coverage Limit $7,400

Prescription Drug Costs and Coverage

The Mutual of Omaha Rx Premier (PDP) plan offers the following prescription drug coverage, with an annual drug deductible of $505 (excludes Tiers 1 and 2) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $1.00
  • Standard retail $8.00
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Generic
  • Preferred cost-share retail $10.00
  • Standard retail $17.00
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail N/A
  • Standard retail N/A
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Generic
  • Preferred cost-share retail N/A
  • Standard retail N/A
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $3.00
  • Standard retail $24.00
  • Preferred cost-share mail order $2.50
  • Standard mail order $2.50
Generic
  • Preferred cost-share retail $30.00
  • Standard retail $51.00
  • Preferred cost-share mail order $25.00
  • Standard mail order $25.00
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