Page 5 - 2021 ASG Benefit Guide

Medical and pharmacy plan overview

We offer the choice of three medical plans through UnitedHealthcare. All of the medical options
include coverage for prescription drugs through OptumRx. 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
If you are enrolled in one of the
HDHP options, you can pay for these percentage of each eligible expense, toward the out-of-pocket maximum eligible
expenses from your Health Savings and you will pay the rest. health care expenses.
Account (HSA).

Embedded Out-of-Pocket Maximum: Under an embedded out-of-pocket maximum (OOPM), each person only needs to meet
the individual OOPM 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.) Please see the next page for the embedded
individual OOPM amounts applied to family coverage for each of the HDHP options.

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,
΅ Preventive drugs: Many preventive drugs and those administration or monitoring. Most can only be
used to treat chronic conditions like diabetes, high blood filled by a specialty pharmacy and have additional
pressure, high cholesterol and asthma are designated on required approvals.
the Chronic/Preventive Condition Drug List as preventive. ΅ Mail order pharmacy: If you take a maintenance
These prescriptions are covered at 100% (no cost to you) medication on an ongoing basis for a condition like
when you use an in-network pharmacy. high cholesterol or high blood pressure, you can use
΅ Pharmacy coverage: Medications are placed in the mail order pharmacy to save on a 90-day supply of
categories based on drug cost, safety and effectiveness. your medication.
These tiers also affect your coverage.

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