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Consumer Driven Health Plan Pharmacy Program Overview
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The Consumer Driven Health Plan covers prescription drugs in the same way other healthcare expenses are covered:
- We provide you with a Personal Care Account (PCA), where $1,200/$2,400
(Self Only/Self and Family) annually is available to cover your medical needs.
You have flexibility in spending these benefit dollars, and your costs are
covered at 100%.
- If you order prescription medication when you have benefit dollars
available in your Personal Care Account (PCA), you pay nothing. Your
prescription drug is covered at 100%. By using the mail order service or a
network pharmacy, you receive a discounted price. Your PCA account is charged
the discounted cost of the prescription medication, which is subtracted from
the PCA.
- Any benefit dollars remaining in the PCA at year-end are rolled over and
added to the PCA for the next year. This allows you to build savings for
future healthcare needs, including for prescription drug expenses.
- If your expenses exceed the $1,200/$2,400 in the PCA, you pay the next
$600/$1,200 (Self Only/Self and Family) of medical expenses that you incur.
This is called your Deductible.
- If you have expenses over $1,800/$3,600 (PCA + Deductible for
Self Only/Self and Family), Traditional Health Coverage begins. You pay 25%
($10 minimum for retail pharmacy, $15 minimum per mail order) of the discounted cost of prescription medications if you use the
mail order or network pharmacy to purchase prescription drugs.
- Under Traditional Health Coverage, if you do not use your identification
card at a network pharmacy, or if you use a non-network pharmacy, the Plan
provides no benefit and you must pay the full cost of your purchase.
Non-network retail drugs are covered under the in-network benefit only if
necessary and prescribed for sudden illness while traveling outside of the
United States (including Puerto Rico).
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