Page 16 - Skechers 2022 Benefits Guide

FILL PRESCRIPTIONS WITH DRUGS ON THE FORMULARY
A formulary is a list of generic and brand-name drugs that are approved by the Food and Drug Administration (FDA) and are covered under your prescription drug plan. Be sure to check if your drug is listed on the formulary before you fill it. If it isn’t, you’ll pay more for your drug. You can access your plan’s formulary by checking with Anthem Blue Cross; you can find contact information above.
GO GENERIC!
Generic drugs meet the same standards as brand-name drugs, but they can cost much less. Ask your doctor if a generic is available.
Prescription Formulary Names:
Gold PPO and HSA PPO: National Tier 3 Formulary Silver PPO and EPO: Essential Tier 3 Formulary
PRESCRIPTION DRUGS
Anthem Blue Cross has a formulary list of approved and preferred prescription drugs. The formulary is separated into three levels which include Generic, Name Brand, and Non-Formulary Medications. To find out where your medication falls under the formulary list, please visit Anthem’s website at anthem.com/CA or call Member Services. Anthem members can save money by requesting generic medications which will have the lowest copayment under the medical plan. For those members who are taking everyday maintenance drugs, you can save even more when you order your prescription drugs through Anthem’s MAIL ORDER PROGRAM. Ordering prescription refills is a safe and convenient way to obtain medications you take daily for a long period of time because you get a 90-day supply of medication for less money. Anthem Blue Cross members can order refill by mail, phone or at anthem.com/CA.
DRUG MANUFACTURER ASSISTANCE PROGRAM FOR SPECIALTY MEDICATION (FOR ANTHEM EPO AND SILVER PPO PLANS ONLY)
Beginning in January 1, 2022, a drug manufacturer assistance program will be available to all employees and dependents who elect the Silver PPO or EPO plans with Anthem Blue Cross.
This program will supplement your copays for Specialty Medications with a manufacturer coupon to bring your cost to $0. However, you must take action when notified by IngenioRx/Anthem that this assistance is available to you. IngenioRx/Anthem will be reaching out via mail and telephone. PLEASE DO NOT DISREGARD! IF YOU DO NOT TAKE ACTION, you may be responsible for a SIGNIFICANT COST share of your Specialty Medications.
HOW THE PLANS WORK
There are three parts to your medical and prescription drug coverage that you need to understand in order to compare the options.
The annual deductible
Some of the plans offered will have an annual deductible. An annual deductible is how much you have to pay out of your own pocket before your insurance company begins to pay a share of your costs. Other plans do not have annual deductibles and will only require you to pay a flat dollar copay.
How you pay
Once the deductible is met, you pay your share of the “negotiated” cost for in-network services, your insurance carrier will pay the rest. “Negotiated” costs are the fees providers (doctor, hospital, lab, etc.) have agreed to accept for a particular service in exchange for being a part of your insurance carrier’s network. If you go out-of-network, the provider can set their own costs and the insurance company will pay a lower percentage of the bill or charges and can base that on what they consider to be reasonable and customary (R&C) charges. You will pay a higher percentage of the bill plus the difference between what the provider charges and what the insurance company considers to be R&C charges.
Annual out-of-pocket maximum
The plan year out-of-pocket maximum is the most you and your covered family members would have to pay in a year for covered health care costs. Your deductible, coinsurance, and copays all count toward your out-of- pocket maximum. You are protected from the major expenses with an out-of- pocket maximum. If your eligible out-of-pocket expenses reach the maximum, your eligible in-network expenses are covered at 100% for the remainder of the plan year.
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