Page 11 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat

MINOR LEAGUE FIELD PERSONNEL PPO

PRESCRIPTION DRUG COVERAGE

Program
A prescription drug program is offered as part of your

health care benefits. This program covers both non- Medicare Part D
maintenance and maintenance prescription drugs

dispensed by either pharmacy or designated mail service The company’s
prescription drug plan is
Retail Program creditable coverage. That

The retail program provides up to a 31-day supply of means it meets and
medication. Simply present your ID card at a exceeds Medicare Part D
participating pharmacy nationwide and pay the requirements and the
appropriate co-pay for your medication. benefits offered by most
Medicare Part D plans. If
Mail Order Program you are eligible for
The mail service program is a convenient way for you Medicare, you may
order medications. Your prescription is reviewed and continue to receive your
dispensed by registered pharmacists and mailed directly prescription drugs under
this plan. You do not need
to your home.
to enroll in a separate
Maintenance Drugs Medicare D drug plan.
Up to a 90-day supply of maintenance drugs is
available through the mail order pharmacy. Maintenance
medication is a prescription drug anticipated to be Additional information is
required for 6 months or more to treat a chronic available on the intranet.
condition.

Field Personnel Prescription Plan

Retail Pharmacy Copayment Mail Order Copayment
Prescription Tier (31-day supply) (90-day supply)

Generic $10 $20

Brand Name $15 $30
Non-Formulary Brand Name $30 $60

2023 Washington Nationals Benefit Guide Page 11