* These charts are brief descriptions of benefits for plan.
** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand
◊ Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).
□ FPL = Federal Poverty Level
Cost Sharing Reductions (CSR) Plans are available to people who have incomes between 100% and 250% of the Federal Poverty Level (FPL).
The FPL rates for 2021 are: