Page 5 - 2022-23 Drug Plastics Benefit Guide

Highmark Medical and Pharmacy Plan Overview

Drug Plastics medical benefits are provided by Highmark Blue Shield. There are three plans to
choose from: PPO (HSA) Green Plan, PPO Blue Plan, and PPO White Plan. If you choose the PPO
(HSA) Green Plan, then you automatically receive an employer contribution to your Health Savings
Account, as long as you open your HSA with Fidelity within 90 days after August 1, 2022.

If you enroll in one of the medical plans offered by Drug Plastics, your coverage includes the
prescription drug plan provided through Express Scripts. The prescription drug program allows
the purchase of generic, brand name formulary, and non-formulary drugs.

To select the plan that best suits your family, you should 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 the When you reach your out-of-pocket
medical and pharmacy expenses, plan share the cost of covered medical maximum, the plan pays 100% of
except those with a copay, until you and pharmacy expenses. The plan covered medical and pharmacy
reach the deductible. will pay a percentage of each eligible expenses for the rest of the plan year.
You can pay for these expenses from expense, and you will pay the rest. Your deductible and coinsurance apply
your Health Savings Account (HSA). toward the out-of-pocket maximum.

Notice Regarding Special Enrollment
If you are waiving enrollment in the medical plan for yourself or your dependents (including your spouse) because of
other health insurance coverage, you may in the future be able to enroll yourself or your dependents in the medical
plan, provided you request enrollment within 30 days after your other coverage ends. In addition, if you have a new
dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and
your dependents provided you request enrollment within 30 days after the marriage, birth, adoption, or placement
for adoption.

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