Page 12 - 2024 Employee Benefits Guide

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, Accredo, for network discounts to be applied. Contact Express
Scripts for a current list of medications that must be obtained through
the specialty pharmacy program. Express Scripts’ customer service
number is listed in the Benefit Contacts section.

Medical premiums for regular, 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.

Employee Wellness Employee
Full Monthly Tobacco-Free
Coverage Option Monthly Premium Monthly with
Premium Incentive
Premium Incentive all Incentives
Employee Only $720 $409 -$205 -$155 $49

Employee & Children $1,340 $609 -$205 -$155 $249

Employee & Spouse $1,480 $872 -$410 -$155 $307
Employee & Family $2,115 $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 2024 Employee Benefits Guide