Page 13 - Veritone EE Guide 07-19

Veritone’s medical plans include prescription drug coverage for you and your covered dependents.
Retail Pharmacy Pharmacy Tips
Use a retail pharmacy to fill prescriptions for acute conditions
(conditions that do not require the medication to be taken on a regular Use generic and over the counter drugs when available. The best
basis). At a participating pharmacy, you will receive up to a 30 day way to save on prescriptions is to use generic or over the counter
supply of your prescriptions. medications as opposed to brand name drugs. Generic drugs must
Mail Order Pharmacy – Maintenance Medication use the same active ingredients as the brand name version of the
You could pay less for the same medication when you use the mail drug. A generic drug must also meet the same quality and safety
order pharmacy. The mail order pharmacy is a fast, easy and standards.
convenient way to save time and money on your maintenance
medications (drugs that you need to take regularly). You can order Use the mail order benefit for maintenance medications
additional supplies of medication at a discount. See below for details! To save money and time, consider using the mail order pharmacy to
fill your maintenance medications.

Option 1 1 Option 2 Option 3 Option 4 Option 5

Kaiser Anthem Anthem Anthem Anthem
Permanente Blue Cross Blue Cross Blue Cross Blue Cross
Plan Name HMO HMO PPO $500 PPO $1,500 HSA PPO

Deductible $0 $0 $0 $0 $0 $0 Health Deductible Applies

Retail Pharmacy
Tier 1 $10 Copay $10 Copay $10 Copay 50% $10 Copay 50% 20% Max $100 40%
Tier 2 $35 Copay $25 Copay $25 Copay Max $250/Rx $35 Copay Max $250/Rx 20% Max $200 Max $250/Rx
Tier 3 N/A $50 Copay $50 Copay $70 Copay 20% Max $200
Supply Limit 30 Days 30 Days 30 Days 30 Days 30 Days 30 Days 30 Days 30 Days

Mail Order Copay
Tier 1 $20 Copay $20 Copay $20 Copay Not Covered $20 Copay Not Covered 20% Max $200 Not Covered
Tier 2 $70 Copay $50 Copay $50 Copay Not Covered $70 Copay Not Covered 20% Max $400 Not Covered
Tier 3 N/A $100 Copay $100 Copay Not Covered $140 Copay Not Covered 20% Max $400 Not Covered

Supply Limit 100 Days 90 Days 90 Days N/A 90 Days N/A 90 Days N/A