Page 6 - 2019 CareHere Enrollment Guide
P. 6
2019 BENEFITS ENROLLMENT
PRESCRIPTION DRUGS
Your Prescription Drug program is administered by Sav-Rx. The participating pharmacy network includes large drug
store chains such as Walgreens and CVS, as well as many independent pharmacies. Your copayment for preventive
prescriptions vary depending on the type of drug used to fill your prescription. Non-preventive prescriptions are subject
to the calendar year medical deductible and out-of-pocket maximum.
Important Note BCBST Option 1—TN Only BCBST Option 2
Network S
Network P
Regarding Specialty Prescription Drugs*
Medications Retail 30-Day Supply
Procurement programs are Generic
in place that may require Preventive** $5 copay $5 copay
participation in the High Impact Non-Preventive 20% after deductible 20% after deductible
Advocacy program. This Preferred Brand
program manages the use of
selected specialty medications Preventive** $25 copay $25 copay
to reduce or eliminate your Non-Preventive 20% after deductible 20% after deductible
out-of-pocket expense, as Non-Preferred Brand
well as reducing the cost to Preventive** $50 copay $50 copay
the Plan. In order to continue Non-Preventive 20% after deductible 20% after deductible
receiving your medication at
the most afordable cost, your Mail Order 90-Day Supply
prescription will be illed at the Generic
Sav-Rx Specialty Pharmacy. Preventive** $5 copay per 30 day $5 copay per 30 day
Sav-Rx will facilitate your supply supply
enrollment into a manufacturer Non-Preventive 20% after deductible
sponsored coupon program. Preferred Brand
Program medications may be Preventive** $25 copay per 30 day $25 copay per 30 day
discontinued from inclusion of supply supply
the program at any time without Non-Preventive 20% after deductible 20% after deductible
notice. Non-Preferred Brand
Preventive** $50 copay per 30 day $50 copay per 30 day
supply supply
* If you select a brand name drug
when a generic equivalent is Non-Preventive 20% after deductible 20% after deductible
available, the plan will only pay the
cost of the generic drug.
** Drugs included on the Sav-Rx Medical Bi-Weekly Pre-Tax Contributions
preventive drug list. (Full-Time Employees Only)
Option 1 (TN Only) Option 2
Network S Network P
Employee Only $15.00 $25.00
Employee + Spouse $143.07 $162.29
Employee + Child(ren) $86.31 $99.61
Employee + Family $229.72 $252.02
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PRESCRIPTION DRUGS
Your Prescription Drug program is administered by Sav-Rx. The participating pharmacy network includes large drug
store chains such as Walgreens and CVS, as well as many independent pharmacies. Your copayment for preventive
prescriptions vary depending on the type of drug used to fill your prescription. Non-preventive prescriptions are subject
to the calendar year medical deductible and out-of-pocket maximum.
Important Note BCBST Option 1—TN Only BCBST Option 2
Network S
Network P
Regarding Specialty Prescription Drugs*
Medications Retail 30-Day Supply
Procurement programs are Generic
in place that may require Preventive** $5 copay $5 copay
participation in the High Impact Non-Preventive 20% after deductible 20% after deductible
Advocacy program. This Preferred Brand
program manages the use of
selected specialty medications Preventive** $25 copay $25 copay
to reduce or eliminate your Non-Preventive 20% after deductible 20% after deductible
out-of-pocket expense, as Non-Preferred Brand
well as reducing the cost to Preventive** $50 copay $50 copay
the Plan. In order to continue Non-Preventive 20% after deductible 20% after deductible
receiving your medication at
the most afordable cost, your Mail Order 90-Day Supply
prescription will be illed at the Generic
Sav-Rx Specialty Pharmacy. Preventive** $5 copay per 30 day $5 copay per 30 day
Sav-Rx will facilitate your supply supply
enrollment into a manufacturer Non-Preventive 20% after deductible
sponsored coupon program. Preferred Brand
Program medications may be Preventive** $25 copay per 30 day $25 copay per 30 day
discontinued from inclusion of supply supply
the program at any time without Non-Preventive 20% after deductible 20% after deductible
notice. Non-Preferred Brand
Preventive** $50 copay per 30 day $50 copay per 30 day
supply supply
* If you select a brand name drug
when a generic equivalent is Non-Preventive 20% after deductible 20% after deductible
available, the plan will only pay the
cost of the generic drug.
** Drugs included on the Sav-Rx Medical Bi-Weekly Pre-Tax Contributions
preventive drug list. (Full-Time Employees Only)
Option 1 (TN Only) Option 2
Network S Network P
Employee Only $15.00 $25.00
Employee + Spouse $143.07 $162.29
Employee + Child(ren) $86.31 $99.61
Employee + Family $229.72 $252.02
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