70/30 Plan

Medical Plan (In-Network Benefits Only)
Total Deductible $3,000 (Single); $9,000 (Family)
Out-of-Pocket Max (Combined with Pharmacy)  $6,350 (Single); $12,700 (Family)
Coinsurance Member pays 30%, plan pays 70% after deductible is met
Office Visits 70% after deductible is met
X-ray and Lab Work 70% after deductible is met
Preventive Care Covered at  100%
Emergency Room You pay $250 copay (waived if admitted) - does not apply to deductible
Specialist Services & Urgent Care Services 70% after deductible is met
Outpatient Services 70% after deductible is met
Inpatient Services 70% after deductible is met
Enhanced Facility Benefit 90% after deductible is met when you use Baylor or Methodist Hospitals in DFW
Rx Coverage (CVS Caremark) See Pharmacy section for more details
Rx Deductible $750 Individual

75/25 HRA Plan

Medical Plan (In-Network Benefits Only)
  Wellness Incentive Earned Wellness Incentive NOT Earned
Total Deductible $2,500 (Single); $5,000 (Family) $2,500 (Single); $5,000 (Family)
HRA Allocation (City Contribution) $1,000 (Single); $2,000 (Family) $700 (Single); $1,700 (Family)
Out-of-Pocket Maximum (includes pharmacy) $6,350 (Single); $12,700 (Family) $6,350 (Single); $12,700 (Family)
Office Visits 75% after deductible is met 75% after deductible is met
X-ray and Lab Work 75% after deductible is met
Preventive Care Covered at 100%
Emergency Room $250 copay (waived if admitted) per visit, does not apply to deductible, applies to out-of-pocket max
Specialist Services & Urgent Care Services 75% after deductible is met
Inpatient Services 75% after deductible is met
Outpatient Services 75% after deductible is met
Enhanced Facility Benefit 90% after deductible is met when you use Baylor or Methodist Hospitals in DFW
Rx Coverage (CVS Caremark) See Pharmacy section for more details
Rx Deductible Combined with medical deductible above

Medical videos are coming soon.

Prescription Drug Coverage

  70/30 Plan 75/25 HRA Plan
Generic Medications
Ask your doctor or other prescriber if there is a generic available, as these generally cost less. 10% ($10 minimum) 10%
Preferred Brand-Name Medications
If a generic is not available or appropriate, ask your doctor or healthcare provider to prescribe from your plan's preferred drug list. 25% ($25 minimum) 25%
Non-Preferred Brand-Name Medications  (includes Specialty Drug Formulary)
You will pay the most for medications not on your plan's preferred drug list. 40% ($40 minimum) 40%
Refill Limit None None
Annual Deductible $750 Individual  $2,500 Individual/$5,000 Family
Out-of-Pocket Maximum

$6,350 Individual

$12,700 Family (Combined with Medical)

$6,300 Individual

$12,700 Family (Combined with Medical)

 
Web Services Register at www.caremark.com to access tools that can help you save money and manage your prescription benefit. To register, have your Prescription Card ready.
Customer Care Visit www.caremark.com or call (855) 465-0023

Copay or coinsurance means the amount a plan participant is required to pay for a prescription in accordance with a plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a plan. 

Prescription Benefit Overview

CVS Caremark Retail Pharmacy Network

  • Short-term medications can be filled at network pharmacies up to 31-day supply. The CVS Caremark Retail Network includes more than 67,000 participating pharmacies nationwide. To locate a pharmacy, click on "Find a Pharmacy" at www.caremark.com.

Long-Term Medications 

Retail 90

  • Pick up your medication at a time that is convenient for you at a retail pharmacy home delivery
  • Enjoy same-day prescription availability
  • Talk with a pharmacist face-to-face
  • For maintenance medications

Mail Service Pharmacy

  • Enjoy convenient home delivery
  • Simply mail your original prescription and the mail service order form to CVS Caremark
  • To sign up, call FastStart at 800-875-0867 or register online at www.caremark.com and select "Start a New Prescription"

Generic Step Therapy

  • For certain high-cost prescription drugs, you may need to try two alternative, generic medications before "stepping up" to a more costly treatment.
  • Pharmacist will let you know at the time of purchase if your prescription requires step therapy.

Dispense As Written Penalty

  • If you elect to fill a brand-name medication when a generic is available, you will pay your generic copay AND the cost difference between the brand-name and the generic medication.
  • Generic drugs can save you money!

Specialty Drug Formulary Prescriptions

  • Certain specialty drug formulary prescriptions, like medications for complex conditions such as cancer and autoimmune disorders, must be filled with a drug on CVS/Caremark's approved list.
  • If you choose to fill your prescription with a drug on the "excluded" list, you must pay the full cost of that drug.