Page 5 - Goodwill of SWPA 2022 Benefits Guide

Medical and pharmacy plan overview

We offer the choice of four medical plans through Highmark and UPMC. All of the medical options 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
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. with coinsurance. The plan will pay a expenses for the rest of the plan year.
You can pay for these expenses from percentage of each eligible expense, Your deductible and coinsurance apply
your Health Savings Account (HSA). and you will pay the rest. toward the out-of-pocket maximum
eligible health care expenses.

Member Websites
Detailed information about the provider networks and carrier prescription formularies can be found on the carrier’s website:
● Highmark Members: http://www.highmarkbcbs.com ● UPMC Members: http://www.upmchealthplan.com

Making the most of your plan
Getting the most out of your plan also depends on how ● Generic: A drug that offers equivalent uses, doses,
well you understand it. Keep these important tips in mind strength, quality and performance as a brand-name
when you use your plan. drug, but is not trademarked.
● In-network providers and pharmacies: You will always ● Brand preferred: A drug with a patent and trademark
pay less if you see a provider within the medical and name that is considered “preferred” because it is
pharmacy network. appropriate to use for medical purposes and is usually
● Preventive care: In-network preventive care is covered less expensive than other brand-name options.
at 100% (no cost to you). Preventive care is often ● Brand non-preferred: A drug with a patent and
received during an annual physical exam and includes trademark name. This type of drug is “not preferred” and
immunizations, lab tests, screenings and other services is usually more expensive than alternative generic and
intended to prevent illness or detect problems before brand preferred drugs.
you notice any symptoms. ● Specialty: A drug that requires special handling,

● Mail Order Pharmacy: If you take a maintenance administration or monitoring. Most can only be
medication on an ongoing basis for a condition like filled by a specialty pharmacy and have additional
high cholesterol or high blood pressure, you can use required approvals.
the Mail Order Pharmacy to save on a 90-day supply. ● Formulary: A list of generic and brand preferred
● Pharmacy coverage: Medications are placed in categories prescriptions drugs covered by the health plan.
based on drug cost, safety and effectiveness. These tiers ● Non-Formulary: Prescriptions drugs that are not
also affect your coverage. included on the health plan’s list of covered medications.

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