Page 5 - Creative Snacks 2023 Benefit Guide

Medical and Pharmacy Plan Overview

We offer the choice of two medical plans through BCBSNC. Both of the medical options include
coverage for prescription drugs through BCBSNC. To select the plan that best suits your family, consider
the key differences between the plans, the cost of coverage (including payroll deductions) and how
the plan covers services throughout the year.

Understanding how your plan works

1. Your deductible 2. Your coverage 3. Your out-of-pocket maximum
΅ You pay out-of-pocket for most ΅ Once your deductible is met, you and ΅ When you reach your out-of-pocket
medical and pharmacy expenses, the plan share the cost of covered maximum, the plan pays 100% of
except those with a copay, until you medical and pharmacy expenses. covered medical and pharmacy
reach the deductible. The plan will pay a percentage of expenses for the rest of the
΅ If you are enrolled in either medical plan, each eligible expense, and you will plan year. Your deductible and
you can pay for these expenses from pay the rest. coinsurance apply toward the
your Health Savings Account (HSA). out-of-pocket maximum.

The difference between aggregate and embedded deductibles and out-of-pocket maximums
΅ With an aggregate approach, one family limit applies to everyone. When one or a combination of family members has expenses
that meet the family deductible or out-of-pocket maximum, it is considered to be met for all of you. Then, the plan will begin
paying its share of eligible expenses for the whole family for the rest of the year.
΅ With an embedded approach, each person only needs to meet the individual deductible and out-of-pocket maximum before the
plan begins paying its share for that individual. (And, once two or more family members meet the family limits, the plan begins
paying its share for all covered family members.)

Making the most of your plan ΅ Mail order pharmacy: If you take a maintenance
medication on an ongoing basis for a condition like
Getting the most out of your plan also depends on how
well you understand it. Keep these important tips in mind high cholesterol or high blood pressure, you can use
when you use your plan. the Mail Order Pharmacy to save on a 90-day supply.
΅ Prescription categories: Medications are categorized
΅ In-network providers and pharmacies: You will always by cost, safety and effectiveness. These tiers also affect
pay less if you see a provider within the medical and your coverage.
pharmacy network.
΅ Preventive care: In-network preventive care is covered ΅ Generic – A drug that’s equivalent to brand-name drugs
in use, dose, strength, quality and performance, but is
at 100% (no cost to you). Preventive care is often not trademarked.
received during an annual physical exam and includes
immunizations, lab tests, screenings and other services ΅ Brand preferred – A drug with a patent and trademark
intended to prevent illness or detect problems before name that is considered “preferred” because it’s safe
you notice any symptoms. and effective and usually less expensive than other
brand-name options.
Understanding your pharmacy coverage ΅ Brand non-preferred – A drug with a patent and
΅ Preventive drugs: Many preventive drugs and those trademark name that is “not preferred” because it’s
used to treat chronic conditions like diabetes, usually more expensive than other generic and brand
high blood pressure, high cholesterol and asthma preferred options.
are on the Preventive Condition Drug List. These ΅ Specialty – A drug that requires special handling,
prescriptions are covered at 100% (no cost to you) administration or monitoring. Most can only be
when you use an in-network pharmacy. filled by a specialty pharmacy and have additional
required approvals.

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