Across
- 1. Pharmacy deductible
- 6. Tiers 1-3 ______________ Pharmacy
- 8. Copay for a specialist o.v. tier 1
- 9. PCP Office Visit-Tier 2 CHC POS Network
- 11. Tier 2 mental health office visit
Down
- 1. Tier 3 ER copay
- 2. Surgery in PCP office-Tier 3
- 3. Individual and Family deductible out of network
- 4. Tier 1 Limited Network HPN—Coinsurance
- 5. ER visit copay Tier 1 HPN
- 7. Home Health Care/Hospice Tier 2
- 8. Individual OPM Tier 2
- 9. Preventive Care/Screening/Immunos Tier 1 or Tier 2
- 10. Tier 3
- 11. Tier 1 A mail order copay