Page 5 - Benefit Guide 2022

Medical and pharmacy plan overview

We offer the choice of three medical plans through Blue Cross Blue Shield. All of the medical options include
coverage for prescription drugs through Elixir Solutions, our pharmacy benefit manager. To select the plan
that best suits your family, you should consider the key differences between the plans, the cost of coverage,
and how the plan covers services throughout the year.

Understanding how your plan works

1. Your deductible 2. Your coinsurance 3. Your out-of-pocket maximum
You pay out-of-pocket for most Once your deductible is met, the When you reach your out-of-pocket
medical and pharmacy expenses plan will pay a percentage of each maximum, the plan pays 100% of
until you reach the deductible. eligible medical and pharmacy ex- covered medical and pharmacy ex-
penses, and you will pay the rest. penses for the rest of the plan year.
Each person only needs to meet Your deductible and coinsurance
the individual deductible before Coinsurance for most medical ex- apply toward the out-of-pocket
the plan begins paying its share for penses is the plan pays 80% and maximum.
that person. And, once two or more you pay 20% until your out-of-
family members meet the family pocket maximum is met.
limit, the plan begins paying its
share for all covered members.

Making the most of your plan • Pharmacy coverage: Medications are placed in
categories based on drug cost, safety and effec-
Getting the most out of your plan also depends on tiveness. These tiers also affect your coverage.
how well you understand it. Keep these important
tips in mind when you use your plan. • Generic — A drug that offers equivalent
uses, doses, strength, quality and perfor-
• In-network providers and pharmacies: You will mance as a brand-name drug, but is not
always pay less if you see a provider within the trademarked.
medical and pharmacy network.
• Brand preferred — A drug with a patent
• Preventative care: In-network preventative care and trademark name that is considered
is covered at 100% ($35 copay for PPO). Pre- “preferred” because it is appropriate to
ventative care is often received during an annual use for medical purposes and is usually
physical exam and includes immunizations, lab less expensive than other brand-name
tests, screenings and other services intended to options.
prevent illness or detect problems before you
notice any symptoms. • Brand non-preferred — A drug with a
patent and trademark name. This type of
• Preventative drugs: Many preventative drugs drug is “not preferred” and is usually
and those used to treat chronic conditions like more expensive than alternative generic
diabetes, high blood pressure, high cholesterol and brand preferred drugs.
and asthma are on the Preventative Drug List
and are covered at 100% for HDHP plan partici- • Specialty—A drug that requires special
pants when you use an in-network pharmacy. handling administration or monitoring.
Most can only be filled by a specialty
• Mail Order Pharmacy: If you take a maintenance pharmacy and have additional required
medication on an ongoing basis, you can use the approvals.
Mail Order Pharmacy to save on a 90-day supply.

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