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Mutual of Omaha Rx Premier (PDP)

Mutual of Omaha Rx Premier (PDP) S7126-086 Plan Details
2 out of 5 stars

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-086.

$60.80
Monthly Premium

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-086.

Mutual of Omaha Rx Premier (PDP) S7126-086 Plan Details
2 out of 5 stars

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-086.

$60.80
Monthly Premium

Illinois Counties Served

Adams Bond Boone Calhoun Dupage Henry Alexander Brown Bureau Carroll Cass Champaign Christian Clark Clay Clinton Coles Cook Crawford Cumberland Dekalb Dewitt Douglas Edgar Edwards Effingham Fayette Ford Franklin Fulton Gallatin Greene Grundy Hamilton Hancock Hardin Henderson Iroquois Jackson Jasper Jefferson Jersey Jo Daviess Johnson Kane Kankakee Kendall Knox La Salle Lake Lawrence Lee Livingston Logan Macon Macoupin Madison Marion Marshall Mason Massac Mcdonough Mchenry Mclean Menard Mercer Monroe Montgomery Morgan Moultrie Ogle Peoria Perry Piatt Pike Pope Pulaski Putnam Randolph Richland Rock Island Saint Clair Saline Sangamon Schuyler Scott Shelby Stark Stephenson Tazewell Union Vermilion Wabash Warren Washington Wayne White Whiteside Will Williamson Winnebago Woodford

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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