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Medical and pharmacy plan overview

We offer the choice of four medical plans through BlueCross BlueShield of Tennessee, Sharp, and Kaiser. All medical options
are in Network S and include coverage for prescription 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 When you reach your out-of-pocket maximum,
medical and pharmacy expenses the plan share the cost of covered the plan pays 100% of covered medical and
until you reach the deductible. medical and pharmacy expenses pharmacy expenses for the rest of the plan
with coinsurance. The plan will pay a year. Your deductible and coinsurance apply
percentage of each eligible expense, toward the out-of-pocket maximum eligible
and you will pay the rest. health care expenses.

The difference between aggregate and embedded deductibles and out-of-pocket maximums
● Under an aggregate approach, there is one family limit that applies to all of you. 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.
● Under 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 well These tiers also affect your coverage.
you understand it. Keep these important tips in mind when
● Generic – A drug that offers equivalent uses, doses,
you use your plan. strength, quality and performance as a brand-name drug,
● In-network providers and pharmacies: You will always but is not trademarked.
pay less if you see a provider within the medical and ● Brand preferred – A drug with a patent and trademark
pharmacy network. name that is considered “preferred” because it is
Preventive care: In-network preventive care is covered
● appropriate to use for medical purposes and is usually
at 100% (no cost to you). Preventive care is often less expensive than other brand-name options.
received during an annual physical exam and includes ● Brand non-preferred – A drug with a patent and
immunizations, lab tests, screenings and other services trademark name. This type of drug is “not preferred” and
intended to prevent illness or detect problems before you is usually more expensive than alternative generic and
notice any symptoms. brand preferred drugs.

● Preventive drugs: Many Preventative drugs are designated ● Specialty – A drug that requires special handling,
on the Affordable Care Act $0 Copay Preventative Drug List. administration or monitoring. Most can only be
These prescriptions are covered at 100% (no cost to you) filled by a specialty pharmacy and have additional
when you use an in-network pharmacy. Please review required approvals.
the Preventative ACA Drug List to check on your own ● Mail order pharmacy: If you take a maintenance
prescriptions to see if included/covered.
medication on an ongoing basis for a condition like high
● Pharmacy coverage: Medications are placed in cholesterol or high blood pressure, you can use the
categories based on drug cost, safety and effectiveness. mail order pharmacy to save on a 90-day supply of your
medication. You only pay 2 times the retail copay for a
90-day supply.
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