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Prescription drug coverage.

As you weigh your options for health plans, you’ll want to think about how prescription drugs are covered in each.

2022
benefits guide.

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All health plans share some similarities with prescription drug coverage, including:

  • Your cost for coverage is included in the paycheck deduction amount for your chosen health plan.
  • Prescription drug expenses count toward your out-of-pocket maximum, the most you’ll pay for health care in a calendar year.
  • You can use pre-tax funds from your HSA and/or Health Care FSA to pay for prescription drug expenses.

Here are the differences in coverage:

Health Plan 1:

  1. First, you pay the full cost until a pharmacy deductible ($100 individual l $200 family) is met. Prescription drugs do not count toward your medical deductible.
  2. Once the deductible is met, you pay a portion of the cost.

Health Plan 3:

  1. First, you pay the full cost until your health plan deductible is met ($1,750 individual l $3,500 family). Prescription drugs count toward your medical deductible.
  2. Once the deductible is met, you pay a portion of the cost.

Health Plan 4 (and both Bind plans for MN only): There is no deductible applied to prescription drugs. You pay a portion of the cost immediately. For Health Plan 4, prescription drugs do not count toward your medical deductible.

How prescription drug coverage works.

Step 1. First, meet the deductible.

Health Plan Deductible
(Individual | Family)
Rx Counts toward Medical Deductible Rx Counts toward Medical OOPM

Health Plan 1

$100* | $200*

 

Health Plan 3

$1,750 | $3,500

Health Plan 4

$0

 

Bind 1 and 2

N/A

 

*This is a pharmacy deductible only and, therefore, is different from the plan’s medical deductible.

Step 2. Then coinsurance applies. What you pay depends on the type of drug, categorized by Tiers 1-3 below.

  Retail Pharmacy (34-day supply) Mail Order (90-day supply)

Tier 1

25% coinsurance
($20 min.; $100 max)

25% coinsurance
($40 min.; $200 max)

Tier 2

40% coinsurance
($40 min.; $150 max)

40% coinsurance
($80 min.; $300 max)

Tier 3

50% coinsurance
($70 min.; $250 max)

50% coinsurance
($140 min.; $500 max)

ID Cards.

Medical and prescription drug ID cards work a bit differently depending on your medical vendor.

  • Blue Cross: You will have two separate ID cards—one for medical and one for prescription drugs.
  • UHC and Bind: Your medical ID card doubles as your prescription ID card.