Page 9 - 2017 Benefits Enrollment

2017 Benefits Enrollment

Classic PPO CDHP
In-Network In-Network Did You Know?
Out-of-Pocket Maximum Prescription Only Your pharmacy plan
Employee $1,500 Medical/Rx deductible covers many tobacco
Employee + 1 $3,000 Medical/Rx deductible cessation drugs at 100
Family $3,000 Medical/Rx deductible percent when received
Prescription Drugs in-network. Talk to
your pharmacist about
Retail supply limit 30 days 30 days your coverage and
Generic $5 copay $0 after deductible take advantage of this
Preferred $25 copay $0 after deductible opportunity to start
Non-preferred $50 copay $0 after deductible living tobacco free.
Mail order supply limit 90 days 90 days Don’t forget to use
Generic $10 copay $0 after deductible Castlight to make sure
Preferred $50 copay $0 after deductible you are getting all
Non-preferred $100 copay $0 after deductible of your drugs at the
lowest possible price.

Your Bi-Weekly Contributions for Medical Care

Classic PPO CDHP
Employee $55.52 $37.24 Mail Order
Employee + 1 $127.04 $75.62 Save time and money
Family $184.61 $99.84 using OptumRx mail
order services. Get a

Reminder! three-month supply of
your maintenance drug
Effective January 1, 2017 our pharmacy administrator for the price of two
months.
will be OptumRx. Express Scripts coverage will end
on December 31, 2016. All members will receive a OptumRx will roll over
new pharmacy ID card from OptumRx to be used on all of your current mail
and after January 1, 2017. order prescriptions
If the new OptumRx card is not received before with the exception
of narcotics, those
December 31, please contact 855.203.0911 , our will have to be set up
benefit service center, to assist with ordering a new again with OptumRx.
card or issuing you a temporary card. The number to call
for assistance is
855.203.0911 .

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