Page 9 - 2017 Benefits Enrollment

2017 New Hire Guide

Classic PPO CDHP
In-Network In-Network Did You Know?
Out-of-Pocket Maximum Prescription Only Your pharmacy plan
Employee $1,500 Medical/Rx deductible covers many tobacco
Employee + 1 $3,000 Medical/Rx deductible cessation drugs at 100
Family $3,000 Medical/Rx deductible percent when received
Prescription Drugs in-network. Talk to
your pharmacist about
Retail supply limit 30 days 30 days your coverage and
Generic $5 copay $0 after deductible take advantage of this
Preferred $25 copay $0 after deductible opportunity to start
Non-preferred $50 copay $0 after deductible living tobacco free.
Mail order supply limit 90 days 90 days Don’t forget to use
Generic $10 copay $0 after deductible Castlight to make sure
Preferred $50 copay $0 after deductible you are getting all
Non-preferred $100 copay $0 after deductible of your drugs at the
lowest possible price.

Your Bi-Weekly Contributions for Medical Care

Classic PPO CDHP
Employee $55.52 $37.24 Mail Order
Employee + 1 $127.04 $75.62 Save time and money
Family $184.61 $99.84 using OptumRx mail
order services. Get a
three-month supply of
your maintenance drug
for the price of two
months.

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