Page 7 - 2016 Open Enrollment Non-Union
P. 7
Hussmann Corporation
Prescription Drugs
When you enroll for medical coverage through Hussmann, you automatically receive prescription drug
coverage for you and your covered dependents. The prescription drug plan is administered by OptumRx, a
UnitedHealthcare company. Visit www.welcometouhc.com/optumrx to ensure your pharmacy is in-network, and
review the Prescription Drug List (PDL) to see how your prescriptions are covered.
Hussmann understands some medications and supplies can help prevent disease or manage existing conditions
to try and avoid future complications. For this reason, Hussmann sponsors an enhanced preventive prescription
drug and diabetic supply list, where you pay $0 for select prescriptions/supplies which help you prevent chronic
health conditions. A link to the $0 preventive drug list and the diabetes medicine and supply list can be accessed
on the Hussmann Intranet by going to: HR Links>Human Resources>Total Rewards>Healthcare Beneits.
PPO HDHP
Deductible
None Subject to medical plan deductible
Prescription Drug Retail (30-day supply)
Preventive drug list $0 copay $0 copay no deductible
Tier 1 $6 copay* $6 copay after deductible**
Tier 2 35% coinsurance 35% coinsurance after deductible
Tier 3 35% coinsurance 35% coinsurance after deductible
Tier 4 (Speciality) 30% coinsurance Ded then 30% coinsurance (coinsurance maximum is
($50 maximum per prescription) $50 per prescription)
Prescription Drug Mail Order (90-day supply)
Preventive drug list $0 copay $0 copay no deductible
Tier 1 $15 copay* $15 copay after deductible**
Tier 2 30% coinsurance Ded then 30% coinsurance (coinsurance maximum is
($150 maximum per prescription) $150 per prescription)
Tier 3 30% coinsurance Ded then 30% coinsurance (coinsurance maximum is
($150 maximum per prescription) $150 per prescription)
Tier 4 30 day supply; 30% coinsurance ($50 maximum 30 day supply; ded then 30% coinsurance
per prescription) (coinsurance maximum is $150 per prescription)
Must use OptumRx 30% coinsurance Ded then 30% coinsurance (coinsurance maximum is
Specialty Pharmacy ($50 maximum per prescription) $150 per prescription)
Pharmacy Annual Out-of-Pocket
$1,500 individual Included in medical out-of-pocket maximum
$3,000 family
* Applies toward the annual pharmacy out-of-pocket maximum.
** Applies toward the medical out-of-pocket maximum.
7
Prescription Drugs
When you enroll for medical coverage through Hussmann, you automatically receive prescription drug
coverage for you and your covered dependents. The prescription drug plan is administered by OptumRx, a
UnitedHealthcare company. Visit www.welcometouhc.com/optumrx to ensure your pharmacy is in-network, and
review the Prescription Drug List (PDL) to see how your prescriptions are covered.
Hussmann understands some medications and supplies can help prevent disease or manage existing conditions
to try and avoid future complications. For this reason, Hussmann sponsors an enhanced preventive prescription
drug and diabetic supply list, where you pay $0 for select prescriptions/supplies which help you prevent chronic
health conditions. A link to the $0 preventive drug list and the diabetes medicine and supply list can be accessed
on the Hussmann Intranet by going to: HR Links>Human Resources>Total Rewards>Healthcare Beneits.
PPO HDHP
Deductible
None Subject to medical plan deductible
Prescription Drug Retail (30-day supply)
Preventive drug list $0 copay $0 copay no deductible
Tier 1 $6 copay* $6 copay after deductible**
Tier 2 35% coinsurance 35% coinsurance after deductible
Tier 3 35% coinsurance 35% coinsurance after deductible
Tier 4 (Speciality) 30% coinsurance Ded then 30% coinsurance (coinsurance maximum is
($50 maximum per prescription) $50 per prescription)
Prescription Drug Mail Order (90-day supply)
Preventive drug list $0 copay $0 copay no deductible
Tier 1 $15 copay* $15 copay after deductible**
Tier 2 30% coinsurance Ded then 30% coinsurance (coinsurance maximum is
($150 maximum per prescription) $150 per prescription)
Tier 3 30% coinsurance Ded then 30% coinsurance (coinsurance maximum is
($150 maximum per prescription) $150 per prescription)
Tier 4 30 day supply; 30% coinsurance ($50 maximum 30 day supply; ded then 30% coinsurance
per prescription) (coinsurance maximum is $150 per prescription)
Must use OptumRx 30% coinsurance Ded then 30% coinsurance (coinsurance maximum is
Specialty Pharmacy ($50 maximum per prescription) $150 per prescription)
Pharmacy Annual Out-of-Pocket
$1,500 individual Included in medical out-of-pocket maximum
$3,000 family
* Applies toward the annual pharmacy out-of-pocket maximum.
** Applies toward the medical out-of-pocket maximum.
7
