Page 13 - 2022 Penn Engineering Guide

Your Prescription Coverage

PRESCRIPTION DRUG PROGRAM

Prescription drugs will be covered under a Prescription Drug Program through Synchrony
Rx powered by CVS/Caremark.
Note the following Plan items:
• Prior Authorization
• Step Drug Therapy
• Drug Quantity Management
• Utilization Management
• Elimination of Compounds
If you are enrolled in the CDHP, the program may pay 100% of prescription drug
expenses for Preventive Drugs (listing available) with no deductible or co-pay. Exceptions
may apply. For Non- Preventive Drugs after you reach your deductible you are
responsible for the co-pays of $10/40/60 if you are enrolled in the CDHP Option.

If you are enrolled in the PPO Plan, the program pays 100% of prescription drug
expenses after you make a $10 co-pay for generic drugs; a $40 co-pay for brand
formulary drugs; and a $60 co-pay for brand non-formulary drugs when using a
participating pharmacy. For a list of participating pharmacies,
visit www.caremark.com or call CVS/Caremark customer service: 1-800-552-8159.

PRESCRIPTION DRUGS
Maintenance Medication

For all maintenance medications, you may use the Mail Order and have the prescriptions

sent directly to your home or have your 90- day prescription filled at a CVS pharmacy for
pick-up.
Prescription Drugs - Specialty
A 15% co-pay will apply for all Specialty Pharmacy drugs after deductible.

YOUR DENTAL BENEFITS
MetLife Dental Plans
The Company will pay 50% of your Dental Premium. The Plan year for the Voluntary
Dental Plan is January 1, 2022 to December 31, 2022. You must enroll during Open
Enrollment, coverage is not automatic. The Company gives you and your eligible
dependents access to quality, cost-effective dental coverage. You may want to review
your dental benefit coverage to help you make your Health Care Flexible Spending
Account and your H S A elections.

MetLife Vision Access
If you participate in a Metlife Dental Plan, you are eligible for Metlife Vision Access. It’s a
Vision Discount Program that provides savings on eye exams; discounts on glasses and
frames; lower costs for laser vision correction; offering a choice of quality providers. No
enrollment or claim forms are necessary. Provide the program code: MET2020 when
making an appointment or receiving services.
12