Page 6 - Watermark Retirement Communities 2022 Benefits Guide Logan Square Union Before

Medical and Pharmacy Plan Overview

Watermark offers a choice of three medical plan options. All of the medical options include coverage for
prescription drugs through carrier. 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 medical For the Select and Enhanced plans, your When you reach your out-of-pocket
and pharmacy expenses until you reach deductible will not apply to the office maximum, the plan pays 100% of
the deductible. visit copays. Deductibles will only apply covered medical and pharmacy
on these plans for services other than an expenses for the rest of the plan year.
You can pay for these expenses with office visit copay or a pharmacy copay. Your deductible, copays and
your Health Savings Account (HSA) if
coinsurance apply toward the out-of-
enrolled in the Consumer Driven Plan or
The Consumer Driven requires that all pocket maximum eligible health care
Flexible Spending Account (FSA).
claims apply to the deductible. Your expenses.
deductible must be met before your
pharmacy copays begin.

Once your deductible is met, you and
the plan share the cost of covered
medical and pharmacy expenses with
coinsurance. The plan will pay a
percentage of each eligible expense,
and you will pay the rest.

Making the most of your plan  Generic – A drug that offers equivalent uses, doses,
strength, quality and performance as a brand-name drug,
Getting the most out of your plan also depends on how well but is not trademarked.
you understand it. Keep these important tips in mind when  Brand preferred – A drug with a patent and trademark
you use your plan.
name that is considered “preferred” because it is
 In-network providers and pharmacies: UHC has a very appropriate to use for medical purposes and is usually
large network of participating providers which are less expensive than other brand-name options.
contracted to provide cost effective services. You will  Brand non-preferred – A drug with a patent and
always pay less if you see a provider within the medical and trademark name. This type of drug is “not preferred”
pharmacy network. and is usually more expensive than alternative generic
 Preventive drugs: Many preventive drugs and those used and brand preferred drugs.
to treat chronic conditions like diabetes, high blood  Specialty – A drug that requires special handling,
pressure, high cholesterol and asthma are designated on administration or monitoring. Most can only be filled
the Preventive Care Drug list as defined by Health Care by a specialty pharmacy and have additional required
Reform as preventive. These prescriptions are covered at approvals.
100% (no cost to you) when you use an in-network  Mail order pharmacy: If you take a maintenance
pharmacy. medication on an ongoing basis for a condition like high
 Pharmacy coverage: Medications are placed in tiers based cholesterol or high blood pressure, you can use the mail
on drug cost, safety and effectiveness. These tiers also order pharmacy to save on a 90-day supply of your
affect your coverage. medication.

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