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Prescription Drugs - Express Scripts
<br /> With the election of a medical plan, employees are automatically enrolled in the corresponding Express Scripts'
<br /> Prescription Drug Plan. The information below is a summary of prescription drug coverage only. Please contact
<br /> Express Scripts, the Prescription Drug Benefits Administrator, at Express-Scripts.com for more information
<br /> detailing coverage information, limitations and exclusions.
<br /> The copays shown are amounts for which you are responsible.
<br /> Blue Options 05770 Blue Options 05772 Blue Options 05774
<br /> Benefit In-Network Out-of- In-Network Out-of- In-Network Out-of-
<br /> Network Network Network
<br /> Retail (31 day supply)
<br /> Generic $10 $10 $10 $10 $10 $10
<br /> Preferred Brand $30 $30 $50 $50 $50 $50
<br /> Non-preferred Brand $60 $60 $80 $80 $80 $80
<br /> Mail Order(90 day supply)
<br /> Generic $20 $20 $20 $20 $20 $20
<br /> Preferred Brand $60 $60 $100 $100 $100 $100
<br /> Non-preferred Brand $120 $120 $160 $160 $160 $160
<br /> Opt-Out Medical Insurance Option
<br /> The District offers an annual flex spending amount of$480 to any employee who actively opts-out of medical
<br /> coverage during open enrollment. If you choose to decline the District's medical coverage and opt out, the
<br /> District will deposit$20.00 per pay period into your flex spending account, beginning October 1, 2020. In order
<br /> to be eligible you MUST elect the "OPT-OUT" flex during Open Enrollment and you MUST show proof of
<br /> other coverage to receive this credit. If you are a late hire or leave the district early, the $480 credit will be
<br /> prorated based on the time you are with the District during the plan year.
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