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PRESCRIPTION COVERAGE
Program
A prescription drug program is offered as part of your health care
benefits. This program covers both non-maintenance and maintenance
prescription drugs dispensed by either pharmacy or designated mail
service
Medicare Part D
Retail Program The company’s prescription drug plan
The retail program provides up to a 31-day supply of medication. Simply is creditable coverage. That means it
present your ID card at a participating pharmacy nationwide and pay meets and exceeds Medicare Part D
the appropriate co-pay or coinsurance amount for your medication. requirements and the benefits offered
by most Medicare Part D plans. If you
are eligible for Medicare, you may
Mail Order Program continue to receive your prescription
drugs under this plan. You do not
The mail service program is a convenient way for you order need to enroll in a separate Medicare
medications. Your prescription is reviewed and dispensed by D drug plan.
registered pharmacists and mailed directly to your home.
Maintenance Drugs
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 required for 6 months or more to treat a chronic
condition.
PPO Prescription Plan PPO Prescription Plan
$150 Individual Deductible
Prescription Drug Deductible $450 Family Deductible
(separate from medical)
$20 Generic
Retail: 31-Day Supply $30 Brand
$60 Non-Formulary Brand
$40 Generic
Maintenance Drugs through Mail Order: 90- day supply $60 Brand
$120 Non-Formulary Brand
2023 Hickory Crawdads Benefit Guide Page 8
