2012 Partnership Promise

• Participate in health coaching if an
opportunity to improve your health is
identified by the Partners for Health wellness staff
• Keep address, phone number and email, if you have one, current with your employer
You do NOT have to have a health screening or complete a questionnaire in 2012

See our FAQ for more information.

Home | Enrollment | Benefit Changes

2012 Benefit Enhancements

Urgent Care Copays

The copay to receive services at a convenience clinic or urgent care facility, such as a MinuteClinic®, Take Care ClinicSM or The Little ClinicSM , will decrease by $20 in each PPO option in 2012. The copay is the same for in- and out-of-network facilities.

Physician Office Visit Out-of-Pocket Copay Maximum

To reduce expenses for members who require frequent doctor visits, there will be a limit on the amount of money you pay in copays for in-network primary and specialty care. This benefit excludes the following:

Visits subject to deductible and coinsurance, such as physical, occupational or speech therapy
Chiropractic office visits

This out-of-pocket maximum is separate from your out-of-pocket maximum for services that require coinsurance.

Out-of-Pocket Copay Maximums (per individual)

Partnership PPO — $900
Standard PPO — $1,100
Limited PPO — $1,100

Deductible and Out-of-Pocket Maximum Decrease

To correct a cost difference for two married employees who both work for an agency that participates in our plans, the deductible and out-of-pocket coinsurance maximum will decrease in 2012 for the "Employee + Child(ren)" premium category. This applies to both in- and out-of-network costs in both PPOs.

Late Applicant Fee

In 2012, the monthly late applicant fee for members who joined the plan during the 2011 AETP will be less. In addition, employees or their eligible dependents who did not join the health plan when they were initially eligible will be allowed to enroll in benefits during AETP if they agree to pay the monthly late applicant fee while they are enrolled through December 31, 2013.

See more information about the Late Applicant Fee »

Pharmacy

In 2012, copays will be lower for certain medications from the special, less costly 90-day network. Diabetic medications and supplies will no longer be provided free of cost in 2012. However, the plans are making changes to the pharmacy benefit on certain drug classes for members who choose to use the mail order benefit or a 90-day network retail pharmacy.

As an incentive to use pharmacies that cost the plan less, there will be lower co-pays on a large group of maintenance drugs. For diabetics, the cost of some medications may go up compared to what you were paying previously. However, the cost of other drugs you are taking will probably go down depending on your particular situation.

Below is a list of the drug groups that will cost less for members obtaining a 90-day supply:

Statins (cholesterol lowering drugs)
Oral diabetic medications, insulins and supplies
Anti-hypertensives, including beta blockers, calcium channel blockers, diuretics and ACE/ARBs (angiotensinconverting enzyme inhibitors and angiotensin receptor blockers)

Some of the more common drugs used by our plan members which will be eligible for the reduced co-pays are: Metformin, Glimepiride, Actos, Januvia, Novolog, Simvastatin, Crestor, Lipitor, Pravastatin, Lovastatin, Lisinopril, Hydrochlorothiazide, Amlodipine and Atenolol.

Please call CVS Caremark at 1-877-522-TNRX (8679) to determine if your particular medication may qualify.

If you choose to receive a 90-day supply of a medication listed in the above classes via mail order or from a 90-day mail-at-retail network pharmacy, you will pay the co-pay listed below. For members who choose to receive a 30-day supply of their medication, the normal 30-day co-pay applies.

Tier	Partnership	Standard	Limited
Generic	$5	$10	$10
Preferred Brand	$30	$40	$40
Non-Preferred Brand	$160	$180	$180