Page 12 - Vistra Demo

MYHEALTH HSA PLAN AT-A-GLANCE Prescription Drug Plan At-a-Glance

You Pay:
In-Network
Prescription Drug (Rx) Coverage
Included in medical deductible
Rx deductible
Rx out-of-pocket maximum
Included in medical out-of-pocket maximum
Retail (up to a 30-day supply)
• Preventive, maintenance generic
$0
• All other generics
20% after annual plan deductible
• Preferred brand name
1
20% after annual plan deductible
1
• Non-preferred brand name
Mail order (up to a 90-day supply) 20% after annual plan deductible
• Preventive, maintenance generic $0
• All other generics 20% after annual plan deductible
• Preferred brand name 1 20% after annual plan deductible
• Non-preferred brand name 1 20% after annual plan deductible
Lifetime maximum medical and Rx benefit No lifetime maximums
1 If a generic is available and a brand is requested, a penalty will apply (this applies to retail and mail order).

Prescription Drug Benefits
Maintenance Choice New for 2017: Preventive, maintenance generic drugs will be covered
The Maintenance Choice at 100%.
program gives you and your
family the choice of getting Generic Step Therapy
long-term maintenance If you have an ongoing health condition, such as arthritis or high
medications either through blood pressure, the generic step therapy program requires you to
CVS Caremark Mail Service try a generic alternative medication that is safe and equally effective
Pharmacy or directly from before a brand name medication is paid through your prescription
any CVS/pharmacy retail insurance benefits. Be sure to advise your doctor that our plan uses
store. Either way, your copay step therapy.
will be the same.
Look under the MyHR tab on Connect and click on HR Services for
an informative video and a list of drugs included in this program.

Your Prescriptions, Ready Together
With ScriptSync, you can pick up all your eligible maintenance
prescriptions with one monthly pharmacy visit — at no cost to you.
Your pharmacy will refill your prescriptions each month and let you
know when they’re ready.
Talk to your CVS pharmacy about which of your 30-day prescriptions
are eligible for you to pick up together and to find a convenient pickup
date for you.

10