Western Plans

WESTERN DEDUCTIBLE PLANS

Copayment Summaries

Medical with Prescription Drug

New and Renewing Plans in 2025

Western 1000/20/20% HMO Prime

• with Rx Classic
• with Rx Plus
• with Rx Base

Western 1000/40/500 HMO Prime

• with Rx Classic
• with Rx Plus
• with Rx Base

Western 2500/20/500 HMO Prime

• with Rx Classic
• with Rx Plus
• with Rx Base

Western 2500/40/500 HMO Prime

• with Rx Classic
• with Rx Plus
• with Rx Base

Western 2500/0/30% HMO Prime

• with Rx Classic
• with Rx Plus
• with Rx Base

Western 4500/50/40% HMO Prime

• with Rx Classic
• with Rx Plus
• with Rx Base

WESTERN DEDUCTIBLE PLANS

Copayment Summaries

Renewing Plans in 2024

Note: All deductible medical plans include prescription coverage.

• Western 1000/20/20% HMO Prime
• Western 1000/40/500 HMO Prime
• Western 2500/20/500 HMO Prime
• Western 2500/40/500 HMO Prime
• Western 2500/0/30% HMO Prime
• Western 4500/50/40% HMO Prime

RIDERS

Copayment/Benefit Summaries

• Prescription Drug Plans (Renewing plans in 2024)
• Family & Diversity Support
• Infertility
• Hearing Aid Plans
• Healthy Lifestyle Program