Page 11 - 2018 Intertek OE Main Guide
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2018 Benefits Enrollment
Classic PPO CDHP Choose one of these ways
In-Network In-Network to fill your first prescription
Out-of-Pocket Maximum Prescription Only using OptumRx.
Employee $1,500 Medical/Rx deductible Online
Employee + 1 $3,000 Medical/Rx deductible Log in to optumrx.com
Family $3,000 Medical/Rx deductible Select Get Started or
Prescription Drugs Transfer Prescriptions
Retail supply limit 30 days 30 days Select the medication you
Generic $5 copay $0 after deductible would like to switch to home
Preferred $25 copay $0 after deductible delivery
Non-preferred $50 copay $0 after deductible
Mail order supply limit 90 days 90 days By Mail
Generic $10 copay $0 after deductible Get a prescription from your
Preferred $50 copay $0 after deductible doctor for up to a 90-day
Non-preferred $100 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 download an order form
Employee $55.52 $37.24 Mail the new prescription
Employee + 1 $127.04 $75.62 and order form to the
Family $184.61 $99.84 address provided on the
form
Home Delivery with OptumRx
You could save money by ordering up to a 90-day supply of
medication. Make fewer trips to the pharmacy and avoid waiting in
line. Your medication is shipped directly to your home with standard
shipping at no cost to you.
Pharmacists are available around the clock to answer your questions.
With home delivery, you can go online to compare medication pricing,
check the timing for your next order and even set up reminders to take
your medication on time.
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Classic PPO CDHP Choose one of these ways
In-Network In-Network to fill your first prescription
Out-of-Pocket Maximum Prescription Only using OptumRx.
Employee $1,500 Medical/Rx deductible Online
Employee + 1 $3,000 Medical/Rx deductible Log in to optumrx.com
Family $3,000 Medical/Rx deductible Select Get Started or
Prescription Drugs Transfer Prescriptions
Retail supply limit 30 days 30 days Select the medication you
Generic $5 copay $0 after deductible would like to switch to home
Preferred $25 copay $0 after deductible delivery
Non-preferred $50 copay $0 after deductible
Mail order supply limit 90 days 90 days By Mail
Generic $10 copay $0 after deductible Get a prescription from your
Preferred $50 copay $0 after deductible doctor for up to a 90-day
Non-preferred $100 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 download an order form
Employee $55.52 $37.24 Mail the new prescription
Employee + 1 $127.04 $75.62 and order form to the
Family $184.61 $99.84 address provided on the
form
Home Delivery with OptumRx
You could save money by ordering up to a 90-day supply of
medication. Make fewer trips to the pharmacy and avoid waiting in
line. Your medication is shipped directly to your home with standard
shipping at no cost to you.
Pharmacists are available around the clock to answer your questions.
With home delivery, you can go online to compare medication pricing,
check the timing for your next order and even set up reminders to take
your medication on time.
11
