Page 8 - Hussmann- OE Guide 2015 Plan Year
P. 8
Annual
Enrollment
Prescription Drugs
When you enroll for medical coverage through Hussmann, you
Diabetic Kit Rule (DKR) automatically receive prescription drug coverage for you and your
If you order your diabetes supplies covered dependents. The prescription drug plan is administered by
through CVS Caremark Mail Service
Pharmacy at the same time as your CVS Caremark.
insulin or oral medicines(s), you will be
charged the member cost share amount Hussmann understands some medications and supplies can help
for insulin or the highest cost item only. prevent disease or help manage existing conditions to try and avoid
future complications. For this reason, Hussmann sponsors a Diabetic
Supplies include:
Kit Rule (DKR). Please read more about our DKR in the informational
Lancet box to the left. We also feature a preventive medication therapy list in
Lancet devices which you pay $0 for select prescriptions. Additional information and
a link to the Preventive Drug list can be found on Inside Hussmann
Alcohol wipes
(Human Resources>Total Rewards> Healthcare Beneits).
Syringes
PPO CHP
Test Strips Deductible
None Subject to Medical Plan
Note: The DKR requires that supplies Deductible
are bought at the same time insulin or Prescription Drug Retail (30-day supply)
oral medicine(s) is purchased or illed. Preventive Drug List $0 copay $0 copay no deductible
Generic $6 copay* $6 copay after deductible**
Log on to www.Caremark.com Brand 35% coinsurance 35% coinsurance after
or call Customer Care toll-free deductible
at 1-800-772-2301 to reill your Prescription Drug Mail Order (90-day supply)
prescription. Preventive Drug List $0 copay $0 copay no deductible
Generic $15 copay* $15 copay after
deductible**
Brand 30% coinsurance Ded then 30% coinsurance
($150 maximum per (coinsurance maximum is
prescription) $150 per prescription)
Specialty Medications (30-day supply)
Must use CVS 30% coinsurance Ded then 30% coinsurance
Caremark Specialty ($50 maximum per (coinsurance maximum is
Pharmacy prescription) $150 per prescription)
Pharmacy Annual Out-of-Pocket
$1,500 Individual Included in medical out-of-
$3,000 Family pocket maximum
* Applies toward the annual pharmacy out-of-pocket maximum.
** Applies toward the medical out-of-pocket maximum.
8
Enrollment
Prescription Drugs
When you enroll for medical coverage through Hussmann, you
Diabetic Kit Rule (DKR) automatically receive prescription drug coverage for you and your
If you order your diabetes supplies covered dependents. The prescription drug plan is administered by
through CVS Caremark Mail Service
Pharmacy at the same time as your CVS Caremark.
insulin or oral medicines(s), you will be
charged the member cost share amount Hussmann understands some medications and supplies can help
for insulin or the highest cost item only. prevent disease or help manage existing conditions to try and avoid
future complications. For this reason, Hussmann sponsors a Diabetic
Supplies include:
Kit Rule (DKR). Please read more about our DKR in the informational
Lancet box to the left. We also feature a preventive medication therapy list in
Lancet devices which you pay $0 for select prescriptions. Additional information and
a link to the Preventive Drug list can be found on Inside Hussmann
Alcohol wipes
(Human Resources>Total Rewards> Healthcare Beneits).
Syringes
PPO CHP
Test Strips Deductible
None Subject to Medical Plan
Note: The DKR requires that supplies Deductible
are bought at the same time insulin or Prescription Drug Retail (30-day supply)
oral medicine(s) is purchased or illed. Preventive Drug List $0 copay $0 copay no deductible
Generic $6 copay* $6 copay after deductible**
Log on to www.Caremark.com Brand 35% coinsurance 35% coinsurance after
or call Customer Care toll-free deductible
at 1-800-772-2301 to reill your Prescription Drug Mail Order (90-day supply)
prescription. Preventive Drug List $0 copay $0 copay no deductible
Generic $15 copay* $15 copay after
deductible**
Brand 30% coinsurance Ded then 30% coinsurance
($150 maximum per (coinsurance maximum is
prescription) $150 per prescription)
Specialty Medications (30-day supply)
Must use CVS 30% coinsurance Ded then 30% coinsurance
Caremark Specialty ($50 maximum per (coinsurance maximum is
Pharmacy prescription) $150 per prescription)
Pharmacy Annual Out-of-Pocket
$1,500 Individual Included in medical out-of-
$3,000 Family pocket maximum
* Applies toward the annual pharmacy out-of-pocket maximum.
** Applies toward the medical out-of-pocket maximum.
8
