Plan Benefits
Prescription Drug Coverages
All medical options include the same prescription drug coverage, as listed in the 2010-2011 Medical Benefits Highlights Chart (found under Medical Options).
Prescription drug benefits are paid based on a formulary. A formulary is a list of drugs that are covered under the plan. The medicines that are covered fall under three categories: generic, preferred brand name, and not-preferred brand name. If a drug is not on the list, it is not covered by the plan.
HDHP Participants
Note that as a July 1, 2010, you must meet your annual deductible before the plan will pay medical and prescription drug benefits, with the exception of certain preventative medications and medical services not subject to the deductible.
Prescription Drug Programs
Informed Rx is the new pharmacy benefit manager for the Arizona Public Employers Health Pool. Informed Rx has a network of over 60,000 pharmacies nationwide. All major pharmacy chains that were available through the Medco network are also available through the Informed Rx network.
How to use the retail program
- Take your new prescription(s) to a participating retail pharmacy
- Present your NEW Rx prescription ID card and prescription(s) to the pharmacist. If you have refills left on an existing prescription, you only need to present your new ID card to the pharmacist. The pharmacist will tell you your correct copayment. There are no claim forms to file and no waiting for reimbursement if you fill your prescription(s) at a participating pharmacy.
- If you need to find a participating pharmacy in your area, you can call Informed Rx.
How to use Informed Rx by mail
- If you are currently taking medication on an ongoing basis, consider taking advantage of Informed Rx by mail.
- You must get a new prescription from your doctor to take advantage of the Informed Rx by mail program. Ask your doctor to write a prescription for up to a 90-day supply, plus refills. Mail your prescription and required co-payment along with the order form.
90-Day retail still available
- The plan still offers the 90-day retail program, subject to the same copays as mail order.
- If you need to find a participating pharmacy in your area, you can call Informed Rx.
Dental Benefits
Dental benefits are important to your overall health. When you enroll in a medical option, the plan automatically provides dental benefits through the Delta Dental of Arizona network please confirm your employer for details. Delta Dental provides preventive, diagnostic, and restorative dental services. Delta Dental network providers accept pre-negotiated fees, allowing you to pay less for the services you receive.
Voluntary Vision Benefits
The pool also provides voluntary vision benefits. Vision Service Plan (VSP) is the provider network. If you elect this coverage, you can see a VSP provider and receive coverage for eye exams, lenses, and frames.