Page 12 - Sample Calendar Layout EE Guide

The Medical plans include prescription drug coverage for you and your covered dependents.

Retail Pharmacy
Present your medical plan ID card at a participating pharmacy. You will
receive up to a 30-day supply for your prescription. You will pay a SAVE MONEY ON YOUR MEDICATIONS!
copay based on the type of prescription you receive. Kaiser members
generally receive your prescriptions at Kaiser facilities or designated Ask for Generic Drugs
pharmacies in your area. You can save money by asking for generic drugs. The FDA
requires that generic drugs have the same high quality,
Mail Order – Maintenance Medication strength, purity, and stability as brand-name drugs. The next
If you take maintenance medications for conditions such as high blood time you need a prescription, ask your doctor to prescribe a
pressure, asthma or diabetes, Aetna and Kaiser have mail order generic drug when it is available and appropriate.
program can save you time and money.
Use Mail Order
When using the mail order service, you will receive a 3-month (90-day) If you require regular medication for a long-term or chronic
supply for the cost of 2 months. So you pay for two and get one free! condition, such as arthritis, or diabetes, you can save money
For additional information, contact Kaiser or Aetna at the member by using your plan’s mail order service.
services number conveniently located on your ID card or at the
Contacts page in this booklet.

AETNA
PLAN NAME KAISER HMO OAMC/PPO

KAISER & CERTAIN
DESIGNATED PHARMACIES OPEN ACCESS MANAGED NON-NETWORK
CHOICE NETWORK

Retail Copay (30-day supply)
Preferred Generic $15 Kaiser / $25 Other $10 Copay 50%, $250 max
Preferred Brand $30 Kaiser / $40 Other $30 Copay 50%, $250 max
Non-Preferred Generic/Brand N/A $50 Copay 50%, $250 max

Mail Order Copay (90-day supply)
Preferred Generic $30 Kaiser / $50 Other $20 Copay Not Covered
Preferred Brand $60 Kaiser / $80 Other $60 Copay Not Covered
Non-Preferred Generic/Brand N/A $100 Copay Not Covered