Page 9 - Guide
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Prescription Drugs 2017 Beneits Enrollment
When you enroll for medical coverage through Hussmann, you automatically receive prescription
drug coverage for you and your covered dependents. The prescription drug plan is administered by
OptumRx, a UnitedHealthcare company. Visit www.welcometouhc.com/optumrx to ensure your pharmacy is in-
network, and review the Prescription Drug List (PDL) to see how your prescriptions are covered.
Hussmann understands some medications and supplies can help prevent disease or manage existing conditions to try and
avoid future complications. For this reason, Hussmann sponsors an enhanced preventive prescription drug and diabetic
supply list, where you pay $0 for select prescriptions/supplies which help you prevent chronic health conditions. A link to
the $0 preventive drug list and the diabetes medicine and supply list can be accessed on the Hussmann Intranet by going
to: HR Links>Human Resources>Total Rewards>Healthcare Beneits.
PPO HDHP
Deductible
None Subject to medical plan deductible
Prescription Drug Retail (30-day supply)
Preventive drug list $0 copay $0 copay no deductible
Tier 1 $6 copay $6 copay after deductible
Tier 2 35% coinsurance 35% coinsurance after deductible
Tier 3 35% coinsurance 35% coinsurance after deductible
Prescription Drug Mail Order (90-day supply)
Preventive drug list $0 copay $0 copay no deductible
Tier 1 $15 copay $15 copay after deductible
Tier 2 30% coinsurance Ded then 30% coinsurance
Tier 3 30% coinsurance Ded then 30% coinsurance
Specialty Pharmacy (30-day supply)
Tier 4 30% coinsurance; must use OptumRx Ded then 30% coinsurance; must use OptumRx
Pharmacy Annual Out-of-Pocket
$1,500 individual Included in medical out-of-pocket maximum
$3,000 family
Additional Pharmacy Information
Some prescription drugs may require authorization before they can be dispensed. Check with OptumRx to determine if
the prior authorization is required.
X Not all prescription medications are covered by the plan; for example, certain cosmetic and lifestyle medications are
not covered; check with OptumRx for coverage details
X Prescription Drug Lists (PDL) can change throughout the year, please access the most up-to-date PDL at
www.myuhc.com for current members or www.def.welcometouhc.com/optumrx for potential members
X Specialty medications must be illed through OptumRx mail order for 30 day supply
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When you enroll for medical coverage through Hussmann, you automatically receive prescription
drug coverage for you and your covered dependents. The prescription drug plan is administered by
OptumRx, a UnitedHealthcare company. Visit www.welcometouhc.com/optumrx to ensure your pharmacy is in-
network, and review the Prescription Drug List (PDL) to see how your prescriptions are covered.
Hussmann understands some medications and supplies can help prevent disease or manage existing conditions to try and
avoid future complications. For this reason, Hussmann sponsors an enhanced preventive prescription drug and diabetic
supply list, where you pay $0 for select prescriptions/supplies which help you prevent chronic health conditions. A link to
the $0 preventive drug list and the diabetes medicine and supply list can be accessed on the Hussmann Intranet by going
to: HR Links>Human Resources>Total Rewards>Healthcare Beneits.
PPO HDHP
Deductible
None Subject to medical plan deductible
Prescription Drug Retail (30-day supply)
Preventive drug list $0 copay $0 copay no deductible
Tier 1 $6 copay $6 copay after deductible
Tier 2 35% coinsurance 35% coinsurance after deductible
Tier 3 35% coinsurance 35% coinsurance after deductible
Prescription Drug Mail Order (90-day supply)
Preventive drug list $0 copay $0 copay no deductible
Tier 1 $15 copay $15 copay after deductible
Tier 2 30% coinsurance Ded then 30% coinsurance
Tier 3 30% coinsurance Ded then 30% coinsurance
Specialty Pharmacy (30-day supply)
Tier 4 30% coinsurance; must use OptumRx Ded then 30% coinsurance; must use OptumRx
Pharmacy Annual Out-of-Pocket
$1,500 individual Included in medical out-of-pocket maximum
$3,000 family
Additional Pharmacy Information
Some prescription drugs may require authorization before they can be dispensed. Check with OptumRx to determine if
the prior authorization is required.
X Not all prescription medications are covered by the plan; for example, certain cosmetic and lifestyle medications are
not covered; check with OptumRx for coverage details
X Prescription Drug Lists (PDL) can change throughout the year, please access the most up-to-date PDL at
www.myuhc.com for current members or www.def.welcometouhc.com/optumrx for potential members
X Specialty medications must be illed through OptumRx mail order for 30 day supply
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