Get to know your benefits - Presented by: Janet King, Sr. Client Manager 2021 Benefits Overview - Phenom People
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Presented by:
Janet King, Sr. Client Manager
Replay Link:
Get to know https://engage.vevent.com/rt/mmc/index.jsp?seid=7069
Passcode: MMCwebcast
your benefits.
2021 Benefits Overview
9126775.1 8/19 19-13383 1
Welcome
What You Should Know for 2021
Advocate4Me Elite
Key Terms
2021 Medical Plans Overview
Preventive Care
Virtual Visits
UnitedHealthcare Broad and Narrow Networks
Transition of Care
Digital Features
myuhc.com
Finding a Network Provider
Premium Providers
Clinical Support
Programs & Services
Questions?
2
What You Should Know for 2021
New for 2021!
• Advocate4me Elite – Support of a single point of contact that’s dedicated to
helping you with your health plan questions and care you need.
The following plans will continue to be offered in 2021
• Four medical plans available:
$400 Deductible Plan
$900 Deductible Plan
$1,500 Deductible Plan (HSA Compatible)
$2,850 Deductible Plan (HSA Compatible)
You will receive a new ID card if this is the first time you are enrolling in
UnitedHealthcare coverage or if you change your elections at annual
enrollment (such as switch plans or add a dependent). Your new ID card
will be sent prior to January 1st.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 3
Advocate4Me® Elite Service, support and access that goes above
and beyond.
Contact us for help with a personal touch
Phone: Call the member number at 866-540-5954
Chat: Log on to myuhc.com® and click the “Call or Chat” button
We’re available Monday through Friday 8am-8pm. You can also call anytime to speak with a Nurse.
4
Help is a call, email or web chat away. Speak with an Advocate for help: • Understand your benefits and claims. • Talk through your bill or payment. • Find and compare care and cost options. • Maximize your health savings. • Take advantage of all your plan’s health and well- being benefits. Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 5
Key Terms
Deductible
The amount you owe for health care services before your medical plan begins to pay. For example, if
your deductible is $400, your plan won't pay anything except for preventive services until you've met
your $400 deductible for covered health care services subject to the deductible. The deductible may
not apply to all services.
Non-Embedded Deductible - “True Family” (applies to the only $1,500 Deductible
Plan)
The family deductible must be met before anyone in the family can receive benefits. The
combined total of eligible expenses of all family members must equal the family deductible before
any plan benefits are paid for any one member.
Embedded Deductible - Not “True Family” (applies only to the $400, $900 and
$2,850 Deductible Plans)
With embedded deductibles a member can satisfy his or her individual deductible for coverage and
coinsurance to apply. When a family member on the plan meets his or her individual deductible,
plan benefits and coinsurance will apply to subsequent claims for that member.
Co-insurance
Your share of the costs of a covered health care service, calculated as a percent (for example,
20%) of the allowed amount for the service. For example, if the health insurance or plan's allowed
amount for an office visit is $100 and you've met your deductible, your co-insurance payment of
20% would be $20. The health insurance or plan pays the rest of the allowed amount.
Out-of-Pocket
The most you pay during a policy period before your health insurance or plan begins to pay 100%
of the allowed amount. This limit never includes your premium, balance-billed charges or health
care your health insurance or plan doesn't cover.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 6
2021 Medical Plans– Broad and Narrow Networks
Service $400 Deductible Plan $900 Deductible Plan
Deductible (Individual/Family) INN: $400 / $800 INN: $900 / $1,800
(Embedded) OON: $2,500 / $5,000 OON: $3,000 / $6,000
Out-of-Pocket Maximum INN: $2,200 / $4,400 INN: $3,000 / $6,000
(Individual/Family)
*includes deductible and copayments OON: $4,400 / $8,800 OON: $6,000 / $12,000
*includes Rx (Embedded)
General Coinsurance INN: 80% OON: 60% INN: 80% OON: 60%
Office Visit – Preventive INN:100%, no deductible INN:100%, no deductible
OON: 60%, after deductible OON: 60%, after deductible
Office Visit – INN: $20 copay INN: 80%, after deductible
Primary Care OON: 60%, after deductible OON: 60%,after deductible
Office Visit – Specialist INN: $40 copay INN: 80%, after deductible
OON: 60%, after deductible OON: 60%, after deductible
Outpatient Surgery INN: 80%, after deductible INN: 80%, after deductible
OON: 60%, after deductible OON: 60%, after deductible
Hospital INN: 80%, after deductible INN: 80%, after deductible
OON: 60%, after deductible OON: 60%, after deductible
Emergency Room (waived if admitted) INN/OON: $150, then 80% after INN/OON: 80%, after deductible
deductible
Urgent Care / Convenience Care INN: $50 copay INN: 80%, after deductible
OON: 60%, after deductible OON: 60%, after deductible
INN: In-Network
OON: Out-of-Network
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 7
2021 Medical Plans– Broad and Narrow Networks
Service $1,500 Deductible Plan $2,850 Deductible Plan
(HSA Compatible) (HSA Compatible)
Deductible (Individual/Family) (non- INN: $1,500 / $3,000 INN: $2,850 / $5,700
Embedded) *includes Rx OON: $3,000 / $6,000 OON: $5,700 / $11,400
Out-of-Pocket Maximum INN: $3,000 / $6,000 INN: $5,500 / $11,000
(Individual/Family)
*includes deductible and copayments OON: $6,000 / $12,000 OON: $11,000 / $22,000
(non-embedded for $1,500 Plan,
embedded for $2,850 Plan)
*includes Rx
General Coinsurance INN: 80% OON: 60% INN: 70% OON: 50%
Office Visit – Preventive INN: 100%, no deductible INN: 100%, no deductible
OON: 60%, after deductible OON: 50%,after deductible
Office Visit – INN: 80%, after deductible INN: 70%, after deductible
Primary Care OON: 60%, after deductible OON: 50%, after deductible
Office Visit – Specialist INN: 80%, after deductible INN: 70%, after deductible
OON: 60%, after deductible OON: 50%, after deductible
Outpatient Surgery INN: 80%, after deductible INN: 70%, after deductible
OON: 60%, after deductible OON: 50%, after deductible
Hospital INN: 80%, after deductible INN: 70%, after deductible
OON: 60%, after deductible OON: 50%, after deductible
Emergency Room (waived if admitted) INN/OON: 80%, after deductible INN/OON: 70%, after deductible
Urgent Care / Convenience Care INN: 80%, after deductible INN: 70%, after deductible
OON: 60%, after deductible OON: 50%, after deductible
INN: In-Network
OON: Out-of-Network
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 8
Preventive care is
covered 100 percent
in our network.
For more information, check your plan documents.
For a list of preventive care guidelines, visit uhc.com/preventivecare
9
Preventive Care
Preventive Health Care Coverage
Preventive care is covered at 100% in-network
• Immunizations and wellness visits for children
• Adult Screenings
• Prostate Cancer Screening
• Colorectal Cancer Screening
• Mammography/PAP Smear
• Age and frequency may apply reference your plan
documents for details or visit uhc.com/preventive
care.
No Deductible
A preventive health visit can help you see how No Copayment
healthy you are now and help identify any health No Coinsurance
issues before they become more serious. You and 100% Coverage
your doctor can then work together to choose the
care that may be right for you.
10
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 10Virtual Visits AmWell®, Doctor on Demand® and Teladoc® Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 11
UnitedHealthcare Broad (Choice Plus)
Networks
UnitedHealthcare
Passport Connect® with Harvard
Broad (Choice Plus) National
Pilgrim
Network
Ability to access Harvard Pilgrim and UnitedHealthcare No matter where you are in the country, a
networks
• If you receive care in the Harvard Pilgrim network service UnitedHealthcare network doctor, pharmacy,
area, you receive network benefits from Harvard Pilgrim hospital and convenience care clinic are likely
network
• If traveling and receiving care outside the Harvard nearby.
Pilgrim network service area, you receive network
benefits when you use UnitedHealthcare’s network
The UnitedHealthcare network covers
99% of the U.S. population and is
available in 96% of all U.S. counties.
Combined Features
• Access to myuhc.com • Search for a doctor or hospital at
• Co-branded health plan ID card www.myuhc.com®
• Call the number on the back of your health
plan ID card for help from myNurseLineSM or
Customer Care
• Use UnitedHealthcare Health4Me™ on your
smartphone
*Residents of MA, ME or NH ( Harvard Pilgrim Network Area)
12
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 12UnitedHealthcare Narrow (Core) Network
UnitedHealthcare Narrow (Core) Medical Plan Network
UnitedHealthcare’s Narrow Network (Core) benefit designs feature a smaller, more focused
network.
Narrow (Core) networks plans offer the same services and tools of other UHC health benefit plans.
• 181,400+ primary care physicians
• 379,400+ specialists
Visit – www.myuhc.com (do not sign in)
Choose Find a Provider
Choose “Core” Network
Validate your Provider is in-network
Note: Before searching for providers, be sure to check that your home zip code is eligible for the Narrow Network in your benefits
enrollment website.
Available to Residents in NY,NJ,MD,DC,VA,SC,GA,AL,FL,TN,MI,*IL,*IN,MO,TX,CO,CA,OR,WA,AK. Two new states added for 2021: MS & AR.
*IL & IN: Core available within Chicago (Boone, Cook, DeKalb, DuPage, Grundy, Iroquois, Kane, Kankakee, Kendall, Lake, La Salle,
McHenry, Will and Winnebago counties) and NW Indiana (Lake, La Salle and Porter counties) only.
13
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 13Transition of Care
Transition of care gives new UHC members the option to request extended coverage from
their current, out-of-network provider at in network benefits for a limited time due to a
specific medical condition.
o Some examples include: 3rd trimester of pregnancy and/or high risk
pregnancy or non-surgical treatment for cancer (radiation/chemotherapy).
• A member must call UHC Customer Service to initiate the process. If the preliminary
criteria is met, a Transition of Care application will be mailed to the member to be filled
out and returned.
• The Transition of Care application must be made within 30 days of the effective
date of coverage.
• Examples of conditions that do not qualify for Transition of Care include:
o Chronic conditions such as diabetes, arthritis, asthma, kidney disease,
and hypertension that are stable.
o Elective scheduled surgeries.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 14Go digital and get the most
out of your benefits.
Activate your myuhc.com account after enrolling
and gain access to:
• Find network providers and locations.
• Check account balances.
• View and pay claims.
• Estimate costs for care.
• Learn about covered preventive care.
15myuhc.com: Home Page and Log In *Find care and costs, including virtual care. *Review plan information, including deductibles and copays/coinsurance. *Access health and wellness programs and resources. *Check on claim status and pay bills. *Contact UnitedHealthcare, including 24/7 nurse support (live or chat). Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 16
3 easy ways to find a network provider.
Look for the “Find a Doctor”
1 button on myuhc.com®
Call the number on your
2 health plan ID card
Search using the
3 UnitedHealthcare® mobile app
17Want to save?
Use network providers.
Network providers help you save because they provide services at a contracted rate.
UnitedHealthcare’s Covered services
networks include: include1:
978,000+ Doctor office visits
physicians and
health care professionals*
[Prescription drugs]
6,100+
hospitals*
67,000+ Hospital care
pharmacies**
And more
*UnitedHealthcare internal analysis Q2 2019
**As of 3/31/17. Facts 2017 Q1 UnitedHealth Group.
1 This is not the complete list of covered services. For more details, see your official health plan documents.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 18Promoting Quality & Affordability
The UnitedHealth Premium® program evaluates doctors for
quality and cost efficiency to help you choose a doctor with
confidence.
The Premium Care Physician blue hearts symbol will help you
find doctors who have been recognized for following evidence
based medicine.
19
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 19HEALTH4ME
Clinical Support
Call us any time
You may contact the nurse team at
any time if you have questions
about:
• Your health and prescription
benefits
• A new diagnosis
• Finding a primary care physician
• A medical claim
Simply call 1-866-540-5954
for help with any questions related
to your health care. We are here
for you.
20
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 20Programs & Services
Cancer Resource Services
• Personal support from an experienced cancer nurse.
• Help understanding your diagnosis.
• Information to help you make decisions about your care.
Spine and Joint Solution
• Designed to improve surgical outcomes, reduced repeat
hospital visits and more.
• Connect 1-on-1 with experienced orthopedic nurses for
answers to your health questions.
• Understand treatment costs and how you could save
money
• Included as part of your health plan at no additional cost.
• Learn more at myuhc.phs.com/sjs
Asthma Support Program can help you:
• Manage your asthma.
• Avoid triggers.
• Reduce hospital stays.
• Reduce missed days at work or school.
21Programs & Services
Diabetes Support Program
• Connect with experts who can help you:
• Manage your diabetes.
• Manage your medications.
• Improve your diet.
• Exercise.
Bariatric Resource Services Program
• Get education and support before and after weight-loss surgery.
• Our nurse care managers will be there
to help you along the way.
Fertility Solutions Program provides:
• Access to trained fertility nurses who will answer questions and help explain treatment
options.
• Help with finding network doctors, clinics and facilities that are right for you.
• Support in navigating the healthcare system and how to best use your health benefit.
22Learn more:
UnitedHealthcare
Call Center
1-866-540-5954
Questions ?
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 23What You Need to Know About
Your 2021 Prescription Drug Benefit
Administered by Express Scripts
October 2020
24
© 2020 Express Scripts Holding Company. All Rights Reserved.Reminder during today’s webcast
For privacy purposes, please refrain from asking
questions that are specific to medications that you
or a family member may be taking.
25
© 2020 Express Scripts Holding Company. All Rights Reserved.Agenda
About Your Prescription Drug Benefit Administered by Express Scripts
The Features of Your Prescription Drug Benefit
Information You Need to Know About Your Plan’s Prescription
Drug Coverage
Making the Best Use of Your Benefit
What’s New For 2021
We’re Here to Help Answer Your Questions and Address Your
Concerns
26
© 2020 Express Scripts Holding Company. All Rights Reserved.About Your Prescription Drug
Benefit Administered by Express
Scripts
27
© 2020 Express Scripts Holding Company. All Rights Reserved.About Your Prescription Drug Benefit
Your prescription drug benefit is administered by Express Scripts*
2021 new enrollees will receive a Welcome Package containing plan
summary information and a prescription ID card.
In the event you do not have your ID cards
• Call Member Services at (800) 987-8360 to request an ID card or
• Register at www.Express-Scripts.com to print a temporary ID card
or
• Download the Express Scripts™ Mobile App to display a virtual
ID card to your local pharmacist.
*if you are enrolled in an Aetna, Anthem BCBS or UnitedHealthcare $400, $900, $1,500 or $2,850 Deductible Plans.
28
© 2020 Express Scripts Holding Company. All Rights Reserved.About Your Prescription Drug Benefit
You automatically receive prescription drug coverage from Express Scripts
when you elect medical coverage under one of the following plans*:
• $400 Deductible Plan
• $900 Deductible Plan
• $1,500 Deductible Plan
• $2,850 Deductible Plan
Coverage includes the option to purchase short term medications from a
retail pharmacy and maintenance medications from the Express Scripts®
mail-order service or at a Walgreens pharmacy.
Please Note: For all maintenance medications, if you choose to fill a 30-day prescription at a retail
pharmacy other than Walgreens, after the first three fills, you will pay 100% of the cost for all
subsequent fills. This will not be applied to deductible or mmaximum out-of-pocket .
Your prescription drug costs will vary based on whether the medication is a
Generic (Tier 1), Formulary Brand (Tier 2), or Non-Formulary Brand (Tier 3).
If you have questions or need further information to better understand your
prescription drug plan:
• Call Member Services at (800) 987-8360, 24 hours a day, 7 days a week except
Thanksgiving and Christmas or
• Log on to the member website at www.Express-Scripts.com
*if you are enrolled in an Aetna, Anthem BCBS or UnitedHealthcare $400, $900, $1,500 or $2,850 Deductible Plans.
29
© 2020 Express Scripts Holding Company. All Rights Reserved.The Features of Your
Prescription Drug Benefit
30
© 2020 Express Scripts Holding Company. All Rights Reserved.Your Plan’s Drug Coverage
Your plan covers a broad range of medications that fall into three categories:
Tier 1 – Generics
Equivalent to brand-name drugs that have exactly the same dosage, intended use, routes of
administration and strength as the brand drug. Generic drugs most often cost significantly less than
Formulary Brand and Non-Formulary Brand medications.
Tier 2 – Formulary Brands
A broad list of preferred brand-name drugs. Drugs on this list may cost you less than Non-Formulary
Brand medications.
Tier 3 – Non-Formulary Brands
Brand drugs that are not included on the preferred list of covered medications. You may pay more for
these drugs.
Your plan encourages you to choose generic and formulary brand medications. Unless your physician specifically prescribes
a brand-name medication without substitution, prescriptions will be filled with the generic equivalent when allowed by
state law.
If you or your physician requests the brand-name drug when a generic equivalent is available, and there is no medical
reason for the brand-name drug, you will pay your share of the cost for the generic drug in addition to the difference in cost
between the brand and generic drugs .
Please note, that some drugs may not be covered under your prescription benefit when there are similar safe and effective
alternatives.
31
© 2020 Express Scripts Holding Company. All Rights Reserved.How much you will pay toward your prescriptions under the $400 or $900
Deductible Plans*:
Participating Retail Pharmacies
Generic Formulary Brand Non-Formulary Brand
up to a 30-day supply
$400 Deductible Plan $10 $30 $60
30% 30% 45%
$900 Deductible Plan
($10 min / $20 max) ($25 min / $50 max) ($40 min / $80 max)
Express Scripts Mail Order or
Walgreens Pharmacy Generic Formulary Brand Non-Formulary Brand
up to a 90-day supply
$400 Deductible Plan $25 $75 $150
30% 30% 45%
$900 Deductible Plan
($25 min / $50 max) ($62.50 min / $125 max) ($100 min / $200 max)
Note: For all maintenance medications, after the first three fills at a retail pharmacy, if you choose to continue to fill the
prescription at a retail pharmacy, you will pay 100% of the cost for all subsequent fills.
*The deductible does not apply to prescriptions for the $400 and $900 plans.
Under the Affordable Care Act (ACA) certain preventive medications will be covered at 100% and are not subject to a
deductible or copayment. Please note that over the counter (OTC) drugs under ACA require a prescription to be covered at
100%.
32
© 2020 Express Scripts Holding Company. All Rights Reserved.Maximum Out-of-Pocket
The $400 and $900 Deductible Plans have a yearly Maximum Out-of-
Pocket (MOOP) that is combined with your medical carrier.
Express Scripts will share claims with your medical carrier and track
yearly spending – this will reset every year on January 1st.
Once the maximum out-of-pocket is met, your copay will be $0 for
prescriptions (excluding applicable penalties).
PLAN IN NETWORK OUT OF NETWORK
Single - $2,200 Single - $4,400
$400 Deductible Plan
Family - $4,400 Family - $8,800
Single - $3,000 Single - $6,000
$900 Deductible Plan
Family - $6,000 Family - $12,000
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© 2020 Express Scripts Holding Company. All Rights Reserved.High Deductible Health Plan (HDHP) Options:
$1,500 and $2,850 Deductible Plans*
The HDHP is a combined medical and prescription drug benefit. You may make pre-tax
contributions to your HSA and use the funds to help pay for medical and prescription
drug expenses.
You pay 100% of your medical and prescription drug expenses until you meet your
annual deductible.
• Preventive medications are not subject to a deductible but you will still be responsible for the
applicable coinsurance. To find out if your medication is considered preventive – price your
medication on www.express-scripts.com or the Express Scripts™ Mobile App.
Once you have met your deductible, you pay the applicable coinsurance amounts until
you reach your maximum out-of-pocket.
Once you have reached your maximum out-of-pocket, including your deductible, the
plan pays 100% of eligible medical and prescription drug expenses for the remainder of
the benefit year.
Under the Affordable Care Act (ACA) select preventive medications will be covered at
100% and are not subject to a deductible or coinsurance. Please note that over the
counter (OTC) drugs under ACA require a prescription to be covered at 100%.
*The Health Savings Account is a tax-advantaged account available to employees who elect the $1,500 Deductible Plan
or the $2,850 Deductible Plan.
34
© 2020 Express Scripts Holding Company. All Rights Reserved.How much you will pay for your prescription medications under the
$1,500 and $2,850 High Deductible Health Plans:
Participating Retail Pharmacies
up to a 30-day supply
Express Scripts Mail Order or Generic Formulary Brand Non-Formulary Brand
Walgreens Pharmacy
up to a 90- day supply
20%, 20%, 20%,
$1,500 Deductible Plan
after deductible after deductible after deductible
30%, 30%, 30%,
$2,850 Deductible Plan
after deductible after deductible after deductible
Participating Retail Pharmacies
up to a 30-day supply
IN NETWORK OUT OF NETWORK IN NETWORK OUT OF NETWORK
Express Scripts Mail Order or
Deductible Deductible Out-Of-Pocket Out-Of-Pocket
Walgreens Pharmacy
up to a 90- day supply
Single - $1,500 Single - $3,000 Single - $3,000 Single - $6,000
$1,500 Deductible Plan
Family - $3,000 Family - $6,000 Family - $6,000 Family - $12,000
Single - $2,850 Single - $5,700 Single - $5,500 Single - $11,000
$2,850 Deductible Plan
Family - $5,700 Family - $11,400 Family - $11,000 Family - $22,000
Note: For all maintenance medications, after the first three fills at a retail pharmacy, if you choose to continue to fill the
prescription at a retail pharmacy other than Walgreens, you will pay 100% of the cost for all subsequent fills.
35
© 2020 Express Scripts Holding Company. All Rights Reserved.Information You Need to Know
About Your Plan’s Prescription
Drug Coverage
36
© 2020 Express Scripts Holding Company. All Rights Reserved.Information You Need to Know About Your Plan’s
Prescription Drug Coverage
Your plan covers a broad range of medications. You may be subject to several different types of drug management
programs. These include quantity management, prior authorization and step therapy.
Some medications may not be covered by your plan unless you receive approval through a coverage review (e.g.
prior authorization).
• This review helps ensure a particular drug is being prescribed appropriately and in accordance with your plan’s
coverage.
• The review uses plan rules that are based on FDA-approved prescribing and safety information, clinical
guidelines, and uses that are considered reasonable, safe, and effective.
• Some covered medications may also have quantity limits and/or prior authorization requirements (for
example, only for a certain amount or for certain uses) unless you receive approval through a coverage review.
As changes in the marketplace occur, such as when new drugs become available or new indications are approved for
existing drugs, the list of drugs that require a coverage review may be modified. To obtain prior authorization for
coverage, ask your doctor to call Express Scripts at 1 800-753-2851. After Express Scripts receives the necessary
information, you and your doctor will be notified confirming whether or not coverage has been approved.
Specialty medications must be filled through Accredo. Accredo is the Express Scripts specialty pharmacy, and is
your plan’s preferred source for direct delivery of specialty medications. Specialty medications are drugs that are
used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune
deficiency, multiple sclerosis and rheumatoid arthritis.
You may be required to try a preferred drug(s) before a non preferred drug. Any changes will be communicated to
impacted members via a mailing.
Fertility drugs will continued to be covered, subject to a $15,000 lifetime maximum.
37
© 2020 Express Scripts Holding Company. All Rights Reserved.Maintenance Medication Pharmacy Network
• You have two ways to get your maintenance prescriptions.
• Maintenance medications are taken over a sustained period of time to treat chronic conditions.
BENEFITS
• Convenient home delivery from Express Scripts PharmacySM
• A Walgreens Pharmacy
• There are two things you need to do to avoid paying full cost:
• Get a three-month (90-day) supply of your long-term medicine instead of a one-month (30-
day) supply
• Get your three-month supply through one of these two options:
Delivered to you from Express Pick up at a Walgreens Pharmacy
Scripts
• Delivered to your door with FREE • More than 8,500 convenient locations, many
standard shipping open 24/7
• Transfer prescriptions easily online, by • Transfer your prescriptions easily in-store,
phone or via Express Scripts mobile app by phone, online or via Walgreens mobile
• Auto-refills and refill reminders available app
• Talk with a pharmacist by phone 24/7 • Auto-refills and refill reminders available
To choose a three-month supply and avoid paying more, log in or register at express-scripts.com/90day. You can also call
the Member Services number on the back of your member ID card.
38
© 2020 Express Scripts Holding Company. All Rights Reserved.Making the Best Use
of Your Benefit
39
© 2020 Express Scripts Holding Company. All Rights Reserved.Member ID Card
This is a separate ID card in addition to your medical plan’s ID card
The Express Scripts® Mobile App
• Electronic ID card
• Find a pharmacy
• Price a medication
• Reminder notifications
• Order refills
• Activate account on the Express Scripts mobile app or
express-scripts.com
40
© 2020 Express Scripts Holding Company. All Rights Reserved.Getting Started with the Express Scripts Pharmacy
Ask your doctor to fax or submit your
prescription electronically. Prescriptions are
processed and delivered within 5 to 8 calendar days
(after receipt of your prescription).
Mail in your prescription
• Print a mail-order form
• Mail prescription and completed order form to the
Express Scripts Pharmacy
• First-time orders will usually be delivered within 8
to 11 calendar days after
we receive your order
It’s easy to get started with mail service
ePrescribe Web/Mobile App Member Services
Physicians can ePrescribe Savings opportunities called out on Member services can transfer
prescriptions directly to the the dashboard an existing prescription
Express Scripts Pharmacy
Patients can request prescription Mail in your prescription
transfers with a click of a button
41
© 2020 Express Scripts Holding Company. All Rights Reserved.Refilling Prescriptions at the Express Scripts
Pharmacy
When you have a 14-day supply of your medication
remaining, you can order refills:
• Online at www.Express-Scripts.com
Refills for long-term prescriptions filled at
• Call us toll-free at (800) 987-8360 retail can be transferred to the Express
Scripts Pharmacy at
• Mail in your refill slip (included with your last prescription www.Express-Scripts.com
order)
• Express Scripts™ Mobile App
Have some of your prescriptions refilled and sent
automatically - sign up for automatic refills
Refills are processed and delivered within 3 to 5 calendar
days (online or phone orders) or 6 to 9 calendar days
(mailed-in orders) after receipt of your order
You also have the option to get a 90-day supply of your
maintenance medications at any Walgreens Pharmacy.
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© 2020 Express Scripts Holding Company. All Rights Reserved.Using the Express Scripts Mail Order Pharmacy
A convenient, safe, and less costly way to have medications delivered
to you
You can receive up to a 90-day supply of your maintenance
medications
Applies for medications you take on an ongoing basis, such as those
used to treat:
• High Blood Pressure
• High Cholesterol
• Diabetes
To learn more about how to get started:
• Go to www.Express-Scripts.com or
• Call Member Services at (800) 987-8360.
43
© 2020 Express Scripts Holding Company. All Rights Reserved.Have a question about a medication?
Call to speak to a pharmacist
You can call one of our Each Express Scripts
You can call
pharmacists for general Specialist Pharmacist has
an Express Scripts
counseling — or an had specialized training in
Specialist Pharmacist
Express Scripts Specialist the medications used to
24/7 to ask
Pharmacist for complex treat a specific condition,
questions about:
concerns. such as:
High Cholesterol Drug interactions
High Blood Pressure Side effects
Depression Risks and benefits of your
Diabetes medication
Asthma The challenges of taking
Osteoporosis your medication as
prescribed — one of the
Cancer
best ways to help maintain
or improve your health
To speak to a pharmacist, call Member Services at
1-800-987-8360
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© 2020 Express Scripts Holding Company. All Rights Reserved.Generic Medications
When you receive a prescription from your doctor, or if
you are taking brand-name drug today, ask:
If a generic version of the medication is available.
If generic medications are right for you.
If there are any risks if you change from a brand-name
drug to a generic drug.
Eight out of 10 prescriptions filled in the United States
are for generic drugs.
FDA-approved generic drugs are as safe and effective
as their brand-name.
Generics cost less. On average, the cost of a generic
drug is 80% to 85% lower than the brand-name product.
45
© 2020 Express Scripts Holding Company. All Rights Reserved.Registering with Express Scripts
Online access to savings and convenience
Manage your medicines anywhere, any time on the member
website at www.express-scripts.com and the Express
Scripts™ Mobile App
Register now so you can experience:
More savings
Compare prices of medicines at multiple pharmacies. Get free standard
shipping* from the Express Scripts PharmacySM.
More convenience
Get up to 90-day supplies of your long-term medicine sent to your home.
Order refills, check order status, and track shipments. Print forms and ID
cards, if needed.
More confidence
Talk with a pharmacist from the privacy of your home any time, from
anywhere. Find the latest information on your medicine, including
possible side effects and interactions.
More flexibility
Download the Express Scripts mobile app to manage your medicines,
find nearby pharmacies and get directions, and use your virtual ID card
while on the go.
* Standard shipping costs are included as part of your prescription plan benefit.
46
© 2020 Express Scripts Holding Company. All Rights Reserved.Pharmacy That Goes Farther
Get Started Today!
Registering is safe and simple. Your information is secure and confidential. Please have your member ID number or
SSN available
Go to express-scripts.com, select Register Now or download the Express Scripts™ Mobile App for free from your
mobile device’s app store and select Register Now
Complete the information requested, including personal information and member ID number or Social Security
Number (SSN), create your user name and password, along with security information in case you ever forget your
password
Click Register now and you’re registered!
On the final page, you can set preferences** now, or later in My Account on www.express-scripts.com
Click Continue
Members who have Apple’s touch or face ID authentication on their iPhone
or iPad devices can enable it to login to their Express Scripts account on
the mobile app, if desired.
** Preferences include the option to share your prescription information with other adult members of your household (aged
18+) covered under your prescription drug plan.
All covered adults (aged 18+) in the household need to register separately.
When you grant permission to share your prescription information with other registered household members, they can
view your information, place orders on your behalf and more.
The Express Scripts™ Mobile App is available for iPhone®, Android, Windows Phone®, Amazon, and Blackberry® mobile
devices.
47
© 2020 Express Scripts Holding Company. All Rights Reserved.An app that drives better decisions and
healthier outcomes for members on the go
Two-click Order Refills: Automatic Refills:
refilling a prescription in managing auto
just two clicks refills enrollment
Accessibility: Dose Reminders:
focusing on access setting reminders
for all with a more with more options to
inclusive display stay adherent
iOS:
Android:
48
© 2020 Express Scripts Holding Company. All Rights Reserved.What’s New for 2021
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© 2020 Express Scripts Holding Company. All Rights Reserved.Rx Savings Solutions
Rx Savings Solutions helps you and your enrolled family members save
money on prescription drugs. This benefit is available to members enrolled in
the pharmacy plan with Express Scripts*.
An online service that shows you the lowest available prices and lowest-cost
options for the same prescription medications.
Register your account at https://myrxss.com and you’ll automatically be
alerted via text or email when you can save money on prescription(s).
*Applies to Aetna, Anthem & UnitedHealthcare deductible plans.
Questions? Contact RxSS Pharmacy Support.
RxSS’ Pharmacy Support Team is staffed with Certified Pharmacy Technicians available to assist with prescription questions.
They can be reached Monday–Friday from 7 a.m.–8 p.m. CT at 1-800-268-4476 or support@rxsavingssolutions.com.
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© 2020 Express Scripts Holding Company. All Rights Reserved.SaveonSP
• Includes specialty medications classified as “Non-Essential Health Benefits”
with $0 member responsibility.
• Applies only to enrolled members of the $400 and $900 Deductible Plans with
Aetna, Anthem and UnitedHealthcare.
• Medications will continue to be filled through Accredo.
• Includes 150+ medications covering conditions such as Hepatitis C (Hep C),
Multiple Sclerosis (MS), Psoriasis, Inflammatory Bowel Disease (IBD),
Rheumatoid Arthritis (RA), Oncology, and others.
• Will contact those eligible members directly via letter and/or phone.
• If your specialty medication is eligible with the SaveonSP drug List, you must
participate in the SaveonSP program to receive your medications free of
charge ($0).
• You will be responsible for paying full price for the drug if you opt out of the
SaveonSP program.
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© 2020 Express Scripts Holding Company. All Rights Reserved.Livongo Hypertension
Members with hypertension or high blood pressure may qualify for the Livongo for
Hypertension program. If you have any questions, you may contact Livongo member support
at (800) 945-4355.
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© 2020 Express Scripts Holding Company. All Rights Reserved.Livongo Hypertension (continued)
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© 2020 Express Scripts Holding Company. All Rights Reserved.We’re here to help answer your questions
and address your concerns
Visit www.Express-Scripts.com
• Information that you will need to complete registration can be found on
your prescription drug ID card.
• To get the most from your online account, you’ll also need a recent
prescription number to view your personalized information.*
Call Express Scripts Member Services at (800) 987-8360, 24 hours
a day, 7 days a week except Thanksgiving and Christmas.
Visit www.Express-Scripts.com/MMC during annual enrollment, to
compare drug prices within the different plans as well as see
details of each plan.
*A prescription number is not required to register on this site.
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© 2020 Express Scripts Holding Company. All Rights Reserved.Questions
and Answers
For privacy purposes, please refrain from asking
questions that are specific to medications that you
or a family member may be taking.
55
© 2020 Express Scripts Holding Company. All Rights Reserved.56 © 2020 Express Scripts Holding Company. All Rights Reserved.
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