Prescription Drug
You or one of your family members will likely need medication at some point during the year. It’s important to understand your prescription drug plan to make the most of your benefits.
When you enroll in a ZOLL medical plan, you automatically receive prescription drug coverage through OptumRx.
Both plans offer three Tiers of Prescription Drugs.
- Tier 1: Generic prescriptions are just as effective as name brand drugs at a fraction of the cost.
- Tier 2: Preferred Brand prescriptions offer great value for a slightly higher cost.
- Tier 3: Non-Preferred Brand prescriptions cost the most out of pocket.
The plans differ in your out-of-pocket costs.
| Saver Plan With HSA | PPO90 | |
|---|---|---|
| For most prescriptions, the deductible must be met before the plan begins to pay its share of the costs | ✓ | Deductible does not apply |
| For most prescriptions, you will pay a copay based on the Drug Tier | After deductible is met | ✓ |
| If your prescription is on the Preventive Drug List for Consumer Driven Health Plans, the deductible will be waived, and you will only pay a copay based on the Drug Tier | ✓ |
The Patient Protection and Affordable Care Act (PPACA) Drug List is a federally mandated list of medications free of cost to help prevent disease as well as meet unique health care needs. These drugs are at $0 cost regardless of which plan you are enrolled in.
| Prescription Drugs – OptumRx | |||
|---|---|---|---|
| Plan Feature | Retail Pharmacy (30-Day Supply) | Home Delivery/Mail-Order (90-Day Supply) |
|
| Saver Plan with HSA | PPO90 Plan | ||
| PPACA Drug List | $0 | $0 | $0 |
| Preventive Drug List for CDHP Plans | Copay | N/A | Two copays |
| Tier 1 | $10, after deductible | $10 | $20 |
| Tier 2 | $30, after deductible | $30 | $60 |
| Tier 3 | $45, after deductible | $45 | $90 |
| Applies to the plan out-of-pocket maximum | Yes | Yes | Yes |
You can fill your prescriptions at a Retail Pharmacy or through Mail Order. To maximize your savings, follow this guide:
| If your prescription is | Fill your prescription at |
|---|---|
| Short-Term Prescription (30-Day Supply) | Nearest Retail Pharmacy |
| Maintenance or Long-Term Prescription (90 Day-Supply) | Mail-Order Pharmacy |
Maintenance medications are those you take to manage a chronic condition, such as high cholesterol or diabetes. You will receive three months of medication for the cost of two months’ worth of copays. Even better, the medication will be delivered right to your home. Shipping is free.
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