If you elect Medical Plan Option C, you must first meet your combined medical and prescription drug annual deductible before paying coinsurance for all non-preventive medications. For preventive medications, you do not need to meet the deductible. Just pay the copay or coinsurance amounts listed below. Your out-of-pocket cost for preventive medications do not apply toward your deductible amount, but will apply towards you out-of-pocket maximum amount.
Option C Prescription Drug Benefits
2024 Plan Information
Under Medical Plan Option C, your non-preventive prescription drug costs count toward your deductible and out-of-pocket maximum amounts. So, if you are prescribed a non-preventive prescription drug early in the year, it is possible you’ll receive a bill as high as $2,300 for single coverage or $4,600 for family coverage. If you are enrolled in family coverage, you must meet the family deductible amount before the plan will begin to pay benefits for all non-preventive drugs and services. Learn more about how prescription drug benefits work with Medical Plan Option C.
If you have a condition requiring regular, high-cost medications, you may want to consider Medical Plan Options A or B.
Note: Preventive drugs are generally prescribed for people who may be at risk for certain diseases or conditions. This does not include drugs or medicines for treatment of an existing illness or condition.
View the current Express Scripts preventive prescription drug list.
The following chart reflects Option C Prescription Drug Benefits for:
- Preventive drugs
- Non-preventive drugs once the annual deductible is met
| If You Enroll in Option C: Preventive Medications | If You Enroll in Option C: Non-Preventive Medications |
|---|---|
| Annual Deductible | |
Medical and prescription drug deductibles are combined; skip to coinsurance for payment amounts for prescription drugs
| Medical and prescription drug deductibles are combined; skip to coinsurance for payment amounts for prescription drugs
|
| In-Store (up to 30-day supply) | Mail Order (up to 90-day supply) |
|---|---|
| Generic Drugs | |
You pay $10 copay | You pay $20 copay |
| Preferred Brand Drugs | |
You pay 30% coinsurance | You pay 30% coinsurance |
| Non-Preferred Brand Drugs | |
You pay 40% coinsurance ($50 min, $150 max) for non-specialty drugs You pay 40% coinsurance ($50 min, $200 max) for specialty drugs | You pay 40% coinsurance ($125 min, $300 max) for non-specialty drugs You pay 40% coinsurance ($125 min, $400 max) for specialty drugs |
Concerned About the High Deductible?
You may be worried that an unexpected illness or injury can mean major medical bills if you are covered under Option C. When deciding what medical coverage is right for you, consider:
- The money you save in paycheck contributions can be saved in your HSA (up to IRS limits) and used to pay for eligible health care or prescription drugs.
- If you schedule a surgery or other expensive medical procedure, you may elect to contribute more money to your HSA (up to the IRS maximum contribution limits) at any point during the year.
- The out-of-pocket maximum limits the amount you will be responsible to pay in a given year.
- If you elect supplemental Critical Illness, Accident and/or Hospital Indemnity Insurance, you can receive lump-sum payments to help offset high medical bills in the event of serious illness or injury.
- Visit the UHC or Cigna sites to compare costs before you need to see a doctor or undergo a procedure. The cost of services and surgeries can vary, even in the same ZIP code. Comparing costs before selecting your provider can help you avoid overpaying for care, without sacrificing quality.
- Use 2nd.MD to have medical experts review your case and recommend treatment options, which can potentially save you from unnecessary, high-cost treatments.
- Talk to your doctor about generics, preferred-brand drugs and mail order prescriptions. Because non-preventive medications are subject to the combined annual deductible under Option C, using lower-cost options can save you serious cash.