AGENT DETAILS
Sarah Leb (LEB INSURANCE GROUP)
ASKFORSARAH@YAHOO.COM
920.552.4846 Cell
920.243.4100 Office
PLAN SECTION
LEB INSURANCE GROUP
Choose a Plan
Annual Deductible Per Member
Formulary
Retail Co-pay
Formulary Generics
Formulary Brands
Non-Formulary
Mail Order Co-pay
Formulary Generics
Formulary Brands
Non-Formulary
Maximum Benefits Payable
Per Member Per Month
Monthly Rates
Individual
Individual + Spouse
Individual + Child(ren)
Family
Select this Plan
Affordable
No Deductible
Rx Value
 
$10
100%
100%
 
$30
100%
100%
 
$300
 
$41.24
$68.77
$63.43
$83.00
Select this Plan
Signature
$100
Rx Balance
 
$10
$50 OR 50%
Whichever is Greater
100%
 
$30
$150 OR 50%
Whichever is Greater
100%
 
$400
 
$51.42
$89.39
$82.43
$107.96
Select this Plan
Enhanced
$100
Select
 
$10
$30
Whichever is Greater
$70 OR 50%
 
$30
$90
Whichever is Greater
$210 OR 50%
 
$500
 
$102.50
$186.65
$175.43
$224.05
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