BENEFIT HIGHLIGHTS Retail and Mail

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Morris Scott
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1 BENEFIT HIGHLIGHTS Retail and Mail When to Use Mail The most efficient way to fill prescriptions that you take for longterm or chronic conditions is through the Mail Order Service. When to Use Retail The most efficient way to use your retail pharmacy benefit is to present your member I.D. card at a participating retail pharmacy. Your retail plan should be used for medications required on a short-term basis. When you have a prescription filled at a participating pharmacy, present your member I.D. card to the pharmacist, who will use an automated system to verify your coverage and prescription cost. HealthConnect Medical Plan About the HealthConnect Medical Plan which is a consumerdirected health plan (CDHP) With this plan, you will be enrolled in a consumer-directed health plan, which provides medical and prescription coverage. When you enroll in the HealthConnect Medical Plan, you can also enroll in a health savings account (HSA). You can use your HSA to pay for items that apply to your deductible (the amount that you and your dependents pay for healthcare services before your plan's coverage takes effect). For questions about your medical benefit, please call the number on the back of your medical ID Card. About your HealthConnect Health Savings Account (HSA) Your health savings account uses pre-tax dollars, which you can use to pay for your prescription and medical expenses. Unlike a flexible spending account, your HSA is not a use it or lose it account. Contributions to the account accumulate and roll over year to year. Any HSA money that you don't spend stays in your account and can earn interest. For questions about your health savings account, please contact your HSA administrator at (800)

2 Retail and Mail Deductible and Out-of-pocket maximum Deductible: Individual: $1250 Family: $2500 See Deductible section for additional information. Out-of-pocket maximum: Individual: $3500 Family: $7000 See Out-of-pocket section for additional information. Preventive medications: To promote good health and help prevent the need for costly care, eligible preventive medications are available before you've met the deductible for just a coinsurance payment. For all other eligible care, there are three phases: 1. Deductible phase: In this phase, you pay 100% of your eligible expenses until you meet your annual combined medical and prescription drug deductible. Use the HSA funds to help pay these costs. 2. Coinsurance phase: If you've met your annual deductible, you pay only the coinsurance amount until you reach your annual combined medical and prescription drug out-of-pocket maximum. This protects you financially by limiting the amount you'd pay in the event of a catastrophic illness % coverage phase: If you've reached your out-of-pocket maximum for the year, you pay nothing more and your plan pays 100% for additional medical and prescription drug expenses for the remainder of the benefit year. Retail and Mail - Deductible For an individual, the deductible for medical claims and for prescriptions filled either at retail pharmacies or through mail order is $1250 every year. For your family, the deductible for medical claims and for prescriptions filled either at retail pharmacies or through mail order is $2500 every year. Your Deductible contributions start over every year beginning on January 01. If there is single coverage, then the individual must satisfy the single deductible before they qualify for benefits. If there is family coverage, then there is no individual deductible - only the family deductible applies. When the deductible amounts paid by all family members are added together, if the family deductible is satisfied, then the entire family will qualify for benefits.

3 Co-payment/Coinsurance You pay only coinsurance / co-payment amounts for eligible preventive medications. If you have met your deductible, you pay only coinsurance / copayment amounts for other covered medications. Compound Medications: Your plan covers multi-ingredient compound medications. Different co-payments may apply for certain medications. For brand-name medications: For medications that are on your plan's preferred drug list: Your co-payment is 30.00% of the medication's total cost. For medications that are not on your plan's preferred drug list: Your co-payment is 50.00% of the medication's total cost. Base Retail and Mail Coinsurance: For generic medications: Your co-payment is 20.00% of the medication's total cost. For brand-name medications when a generic is available: For medications that are on your plan's preferred drug list: Your co-payment is 30.00% of the medication's total cost. For medications that are not on your plan's preferred drug list: Your co-payment is 50.00% of the medication's total cost. Days Supply Through the Mail Order Service, you can purchase up to a 90-day supply of most prescription medications. There may be limitations on some prescriptions, such as controlled medications, subject to state and federal dispensing limitations. At retail pharmacies, you may purchase up to a 30-day supply of most prescription medications. There may be limitations on some prescriptions, such as controlled medications, subject to state and federal dispensing limitations.

4 Retail and Mail - Out-Of-Pocket Your out-of-pocket expense is the maximum amount you will pay before your plan sponsor reduces your co-payments. For an individual, the out-of-pocket maximum for medical claims and for prescriptions filled either at retail pharmacies or through mail order is $3500 every year. For your family, the out-of-pocket maximum for medical claims and for prescriptions filled either at retail pharmacies or through mail order is $7000 every year. Your out-of-pocket contributions start over every year beginning on January 01. Deductibles, if applicable and co-payments are applied to the outof-pocket maximum. Once this maximum is met, your copayment will change. The out-of-pocket applies to all preferred and non-preferred medications. This information is intended to serve as a general overview of your plan sponsor's prescription benefit program. Please note that the terms of your prescription benefit are subject to change. Please consult your plan sponsor for complete information. Accredo, an Express Scripts specialty pharmacy Accredo, an Express Scripts specialty pharmacy provides a high level of care for patients with chronic or serious conditions, who take drugs that require injection, special handling and monitoring during distribution and usage. These medications are used to treat conditions such as MS, Hepatitis C, Rheumatoid Arthritis, among others. Benefits of using Accredo include: 24/7 access to pharmacists who are trained in specialty medications, their side effects, and the conditions they treat. Expedited delivery to your home or your doctor's office for all your specialty prescription medications. Some supplemental supplies, such as needles and syringes, required to administer the medication may be included at no additional charge.

5 Scheduling of refills and coordination of services with home care providers, case managers, and doctors or other healthcare professionals. Liberty Medical Supply: Express Scripts medical supply and equipment provider Liberty Medical, also known as Liberty Medical Supply, provides medical supplies and equipment under the medical benefit for patients with chronic conditions such as diabetes and sleep apnea. You may be eligible to use Liberty to receive medical supplies and equipment, such as diabetes testing supplies, insulin pumps, ostomy supplies, catheters, orthopedics such as back braces, and continuous positive airway pressure (CPAP) equipment. Benefits of using Liberty Medical Supply include: Access to specialized health educators and medical equipment and supply specialists The convenience of timely supply and equipment delivery to your home or location of choice Access to essential medical supplies and equipment, which may include diabetes testing supplies, insulin pumps, sleep apnea equipment, orthopedics, and items for ostomy care, urological conditions, and erectile dysfunction therapies Confirming your eligibility and getting started with Liberty Medical Supply If you are using medical supplies and equipment today, we encourage you to call Liberty Medical Supply toll-free at A representative will confirm if Liberty is able to provide these supplies through home delivery under your medical benefit. If you're interested in and eligible for Liberty's services, the representative can help you get started right away. This page was last updated on 10/24/ Express Scripts Holding Company. All Rights Reserved.

Prescription Drug Plan

Prescription Drug Plan The prescription drug plan helps you pay for prescribed medications using either a retail pharmacy or the mail order program. For More Information Administrative details and procedures