Page 10 - 2019 Intertek
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2019 BENEFITS ENROLLMENT
Choose one of these ways Classic PPO CDHP
to fill your first prescription In-Network In-Network
using OptumRx. Out-of-Pocket Maximum Prescription Only
Online Employee $1,500 Medical/Rx deductible
Log in to optumrx.com Employee + 1 $3,000 Medical/Rx deductible
Family
Select Get Started or Transfer Prescription Drugs $3,000 Medical/Rx deductible
Prescriptions Retail supply limit 30 days 30 days
Select the medication you Generic $10 copay $0 after deductible
would like to switch to home Preferred $40 copay $0 after deductible
$80 copay
Non-preferred
$0 after deductible
delivery Mail order supply limit 90 days 90 days
By Mail Generic $20 copay $0 after deductible
Get a prescription from your Preferred $80 copay $0 after deductible
doctor for up to a 90-day Non-preferred $160 copay $0 after deductible
supply, plus reills for up to
one year (if needed) Your Bi-Weekly Contributions for Medical Care
Go to optumrx.com and Classic PPO CDHP
$61.07
download an order form Employee $139.75 $40.97
Employee + 1
$83.18
Mail the new prescription and Family $203.07 $109.83
order form to the address
provided on the form Step Therapy
Home Delivery with After clinical studies of many diferent drugs, OptumRx has selected
OptumRx certain drugs to be the irst options tried when treating some
conditions. These drugs have been selected as the “irst step”
You could save money by because studies have shown they are proven to work well for most
ordering up to a 90-day supply of people and are more afordable. Your pharmacy will alert you to
medication. Make fewer trips to the step therapy if a prescription you present is included in a step
the pharmacy and avoid waiting therapy category.
in line. Your medication is shipped
directly to your home with standard Prior Authorization
shipping at no cost to you.
Prior Authorization requirements help ensure drugs are used in
Pharmacists are available around the proper way and in doses that are right for each person as
the clock to answer your questions. recommended by the U.S. Food and Drug Administration. While
With home delivery, you can go most prescriptions can be illed immediately by the pharmacy, some
online to compare medication require further review. If you encounter a prescription that requires
pricing, check the timing for prior authorization, your pharmacy will let you know and either the
your next order and even set up pharmacy or your doctor will work with OptumRx’s Prior Authorization
reminders to take your medication Center to determine if your prescription will be approved as
on time. requested.
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Choose one of these ways Classic PPO CDHP
to fill your first prescription In-Network In-Network
using OptumRx. Out-of-Pocket Maximum Prescription Only
Online Employee $1,500 Medical/Rx deductible
Log in to optumrx.com Employee + 1 $3,000 Medical/Rx deductible
Family
Select Get Started or Transfer Prescription Drugs $3,000 Medical/Rx deductible
Prescriptions Retail supply limit 30 days 30 days
Select the medication you Generic $10 copay $0 after deductible
would like to switch to home Preferred $40 copay $0 after deductible
$80 copay
Non-preferred
$0 after deductible
delivery Mail order supply limit 90 days 90 days
By Mail Generic $20 copay $0 after deductible
Get a prescription from your Preferred $80 copay $0 after deductible
doctor for up to a 90-day Non-preferred $160 copay $0 after deductible
supply, plus reills for up to
one year (if needed) Your Bi-Weekly Contributions for Medical Care
Go to optumrx.com and Classic PPO CDHP
$61.07
download an order form Employee $139.75 $40.97
Employee + 1
$83.18
Mail the new prescription and Family $203.07 $109.83
order form to the address
provided on the form Step Therapy
Home Delivery with After clinical studies of many diferent drugs, OptumRx has selected
OptumRx certain drugs to be the irst options tried when treating some
conditions. These drugs have been selected as the “irst step”
You could save money by because studies have shown they are proven to work well for most
ordering up to a 90-day supply of people and are more afordable. Your pharmacy will alert you to
medication. Make fewer trips to the step therapy if a prescription you present is included in a step
the pharmacy and avoid waiting therapy category.
in line. Your medication is shipped
directly to your home with standard Prior Authorization
shipping at no cost to you.
Prior Authorization requirements help ensure drugs are used in
Pharmacists are available around the proper way and in doses that are right for each person as
the clock to answer your questions. recommended by the U.S. Food and Drug Administration. While
With home delivery, you can go most prescriptions can be illed immediately by the pharmacy, some
online to compare medication require further review. If you encounter a prescription that requires
pricing, check the timing for prior authorization, your pharmacy will let you know and either the
your next order and even set up pharmacy or your doctor will work with OptumRx’s Prior Authorization
reminders to take your medication Center to determine if your prescription will be approved as
on time. requested.
10
