Page 8 - Down East Wood Ducks 2022 Benefits Guide

PRESCRIPTION DRUG COVERAGE

Program
A prescription drug program is offered as part of your health
care benefits. This program
covers both non-maintenance
and maintenance prescription drugs dispensed by either
pharmacy or designated mail service

Retail Program
The retail program provides up to a 31-day supply of
medication. Simply present your ID card at a participating Medicare Part D
pharmacy nationwide and pay the appropriate co-pay or The company’s prescription drug
coinsurance amount for your medication. plan is creditable coverage. That
means it meets and exceeds
Medicare Part D requirements and
Mail Order Program the benefits offered by most
The mail service program is a convenient way for you Medicare Part D plans. If you are
order medications. Your prescription is reviewed and eligible for Medicare, you may
dispensed by registered pharmacists and mailed directly to continue to receive your
your home. prescription drugs under this plan.
You do not need to enroll in a
separate Medicare D drug plan.
Maintenance Drugs
Up to a 90-day supply of maintenance drugs is
available through the mail order pharmacy. Maintenance
medication is a prescription drug anticipated to be required
for 6 months or more to treat a chronic condition.

PPO Prescription Plan In-Network

$150 Individual Deductible
Prescription Drug Deductible $450 Family Deductible
(separate from medical)
$20 Generic
Retail: 31-Day Supply $30 Brand
$60 Non-Formulary Brand

$40 Generic
Maintenance Drugs through Mail Order: 90- Day
Supply $60 Brand
$120 Non-Formulary Brand

2022 Down East Wood Ducks Benefit Guide Page 8