Page 39 - SOLO Member Guidebook

WHICH PLAN?

• Routine hearing screening up to age 21 when benefits for prescription drugs. The drugs are placed
rendered by a primary care provider in a tiered system that indicates what your cost-share
• Dental caries prevention up to age 5 when rendered amount will be.
by a primary care provider
Tier-one drugs have the lowest cost-share level,
• Developmental, autism, and psychosocial/behavioral tier-two drugs have an intermediate cost-share level,
assessments up to age 21 when rendered by a and tier-three and tier-four drugs have the
primary care provider highest cost-share level. To obtain more information
• Dietary counseling for adults with hyperlipidemia on ConnectiCare’s Fredom Drug List, go to www.
or obesity connecticare.com/pharmacy.aspx, or call Member
• Alcohol misuse screening and counseling Services at 1-800-251-7722. Please note that the
• Tobacco cessation interventions drug list can change during the year, so check the
• Screening for Hepatitis B, iron deficient anemia, Rh Web site or call the number above for
(D) blood typing and asymptomatic bacteriuria in the latest information.
women who are pregnant
If your prescription is available as a generic but you
• Screening for abdominal aortic aneurysm in men age
prefer to purchase the brand-name instead, you
65 – 75 who have ever smoked
may do so. However, please note:
• BRCA counseling and genetic screening for women
at risk • You will be responsible for paying the generic
• Physical therapy to prevent falls in adults age 65 cost-share plus the difference in price between
and older the generic and the brand-name drug.

Understanding Your Prescription • The cost of the generic drug will go toward
Drug Coverage meeting the plan deductible – not the cost of
the brand-name drug. (Applies to ConnectiCare
Prescription drugs and supplies are covered under
SOLO High-Deductible Health Plans only.)
all ConnectiCare SOLO Plans. Your plan includes

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