Page 4 - tru fru 2023 Benefit Guide

Medical and Pharmacy Plan Overview

We offer a medical plan through Cigna with coverage for prescription drugs.

Understanding how your plan works

1. Your deductible 2. Your coverage 3. Your out-of-pocket maximum
y You pay out-of-pocket for most y Once your deductible is met, you and y 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. y The plan will pay a percentage of expenses for the rest of the
each eligible expense, and you will plan year. Your deductible and
pay the rest. coinsurance apply toward the
out-of-pocket maximum.

Note: Deductibles and out-of-pocket expenses paid towards the Intermountain medical plan by trü frü’s current Associates
will be honored by CIGNA.

The difference between aggregate and embedded deductibles and out-of-pocket maximums
y 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.
y 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
Getting the most out of your plan also depends on how y Mail order pharmacy: If you take a maintenance
well you understand it. Keep these important tips in mind medication on an ongoing basis for a condition like
when you use your plan. high cholesterol or high blood pressure, you can use

y In-network providers and pharmacies: You will always the Mail Order Pharmacy to save on a 90-day supply.
pay less if you see a provider within the medical and y Prescription categories: Medications are categorized
pharmacy network. by cost, safety and effectiveness. These tiers also affect
y Preventive care: In-network preventive care is covered your coverage.
at 100% (no cost to you). Preventive care is often y Generic – A drug that’s equivalent to brand-name drugs
received during an annual physical exam and includes in use, dose, strength, quality and performance, but is
immunizations, lab tests, screenings and other services not trademarked.
intended to prevent illness or detect problems before y Brand preferred – A drug with a patent and trademark
you notice any symptoms. name that is considered “preferred” because it’s safe
and effective and usually less expensive than other
Understanding your pharmacy coverage brand-name options.
y Preventive drugs: Many preventive drugs and those y Brand non-preferred – A drug with a patent and
used to treat chronic conditions like diabetes, high trademark name that is “not preferred” because it’s
blood pressure, high cholesterol and asthma are on usually more expensive than other generic and brand
the Preventive Condition Drug List. These prescriptions preferred options.
are covered at 100% (no cost to you) when you use an
in-network pharmacy.

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