Page 7 - Hussmann- Bridgeton OE Guide 2015 Plan Year
P. 7
Hussmann Corporation
Prescription
Prescription Drugs Drugs
When you enroll for medical coverage through Hussmann, you
automatically receive prescription drug coverage for you and your Additional Pharmacy
covered dependents. The prescription drug plan is administered by Information
OptumRx, a UHC company. Some prescription drugs may require
authorization before they can be
Hussmann understands some medications and supplies can help dispensed. Check with OptumRx/UHC
to determine if prior authorization is
prevent disease or help manage existing conditions to try and avoid required.
future complications. For this reason, Hussmann sponsors an
Enhanced Preventive Prescription Drug and Diabetic Supply list, Not all prescription medications are
covered by the plan. For example,
where you pay $0 for select prescriptions/supplies which help you certain cosmetic and lifestyle
prevent chronic health conditions. A link to the $0 Preventive Drug medications are not covered. Check
list and the Diabetes Medicine and Supply list can be accessed on the with UHC for coverage details.
Hussmann Intranet by going to: HR Links>Human Resources>Total Prescription Drug Lists (PDL) can
Rewards>Healthcare Beneits. change throughout the year, please
access the most up-to-date PDL at
OptumRx, a UnitedHealthcare Company www.myuhc.com for current members
Pharmacy Beneit Manager PPO or www.uhc.com for potential members
In-Network Out-of-Network
Retail (31-Day Maximum)
Preventive Drug List * $0 copay Not covered
Tier 1 $14 copay
Tier 2 $30 copay
Tier 3 50% coinsurance
Mail Order (90-Day Maximum) $150 Maximum per Prescription or Reill
Preventive Drug List * $0 copay Not covered
Tier 1 20% coinsurance
Tier 2 20% coinsurance
Tier 3 50% coinsurance
Prescription drug charges do not count toward the plan’s out-of-pocket maximum.
* The list of preventive drugs that may be covered is available on the Healthcare Beneits
page through the Hussmann Intranet and via web link in Workday. Additional conditions
apply.
7
Prescription
Prescription Drugs Drugs
When you enroll for medical coverage through Hussmann, you
automatically receive prescription drug coverage for you and your Additional Pharmacy
covered dependents. The prescription drug plan is administered by Information
OptumRx, a UHC company. Some prescription drugs may require
authorization before they can be
Hussmann understands some medications and supplies can help dispensed. Check with OptumRx/UHC
to determine if prior authorization is
prevent disease or help manage existing conditions to try and avoid required.
future complications. For this reason, Hussmann sponsors an
Enhanced Preventive Prescription Drug and Diabetic Supply list, Not all prescription medications are
covered by the plan. For example,
where you pay $0 for select prescriptions/supplies which help you certain cosmetic and lifestyle
prevent chronic health conditions. A link to the $0 Preventive Drug medications are not covered. Check
list and the Diabetes Medicine and Supply list can be accessed on the with UHC for coverage details.
Hussmann Intranet by going to: HR Links>Human Resources>Total Prescription Drug Lists (PDL) can
Rewards>Healthcare Beneits. change throughout the year, please
access the most up-to-date PDL at
OptumRx, a UnitedHealthcare Company www.myuhc.com for current members
Pharmacy Beneit Manager PPO or www.uhc.com for potential members
In-Network Out-of-Network
Retail (31-Day Maximum)
Preventive Drug List * $0 copay Not covered
Tier 1 $14 copay
Tier 2 $30 copay
Tier 3 50% coinsurance
Mail Order (90-Day Maximum) $150 Maximum per Prescription or Reill
Preventive Drug List * $0 copay Not covered
Tier 1 20% coinsurance
Tier 2 20% coinsurance
Tier 3 50% coinsurance
Prescription drug charges do not count toward the plan’s out-of-pocket maximum.
* The list of preventive drugs that may be covered is available on the Healthcare Beneits
page through the Hussmann Intranet and via web link in Workday. Additional conditions
apply.
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