Page 11 - 2022 Benefits Resource Guide

Medical, vision & pharmacy benefits, cont.

Specialty pharmacy program
Some prescription medications are available only through the specialty
pharmacy program for a 30-day supply. You must fill prescriptions that
fall under this program through Express Scripts’ designated specialty
pharmacy for network discounts to be applied. Copays for the specialty
drug are the same as a 30-day supply through a retail network
pharmacy. Contact Express Scripts for a current list of medications
that must be obtained through the specialty pharmacy program. The
specialty pharmacy customer service number is listed in the
benefit contacts section.

Medical premiums for full-time employees
Your premium deductions will begin with the first pay period following
the benefit enrollment effective date. The following table shows the
monthly premium for the medical plan and the available incentives that
may reduce the monthly medical premium you pay.

Monthly Wellness Premium Tobacco-Free Employee
Coverage Option
Premium Incentive Incentive Monthly
Employee Only $409 -$205 -$155 $49
Employee & Children $609 -$205 -$155 $249
Employee & Spouse $872 -$410 -$155 $307

Employee & Family $1,003 -$410 -$155 $438

Spousal premium surcharge
If you elect medical coverage for your spouse who has coverage available
through his/her own employer, you will be required to pay an additional
$150 premium per month.

8 Employee Benefits Guide