2017-2018 College of Marin Benefit Summary

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Medical- Kaiser Rx
Prescription drug coverage provides a benefit that is important to your overall health, whether you need a
prescription for a short-term health issue like bronchitis or an ongoing condition like high blood pressure.
Kaiser Medical HMO
Traditional Plan
Kaiser Medical HMO
Deductible HMO
In-Network In-Network
Pharmacy
Most Generic $10 copay $10 copay1
Most Brand-name $20 copay $30 copay1
Supply Limit 100 days 30 days
Mail Order
Most Generic $10 copay $20 copay1
Most Brand-name $20 copay $60 copay1
Supply Limit 100 days 100 days
1 Not subject to deductible
The information in this booklet is a general outline of the benefits offered under College of Marin benefits program. This booklet may not include all relevant limitations and conditions.
Specific details and limitations are provided in the plan documents, which may include a Summary of Plan Description (SPD), Evidence of Coverage (EOC), and/or insurance policies. The
plan documents contain relevant plan provisions. If the information in this booklet differs from the plan documents, the plan documents will prevail.