CDH UHC

​CDH High Plan

CDH LOW PLAN ELIMINATED, REPLACED WITH NEW NARROW NETWORK PLAN​
Summary of Benefits & Coverage CDH High Plan 
 
No changes to CDH High Plan premium, plan design, deductibles, coinsurance, copays, and out-of-pocket.
 
Highlights of CDH High Plan
  • Preventive services, when billed by Provider as Preventive, covered 100% in-network.
  • Some services received for a copay (Primary, Specialist, Urgent Care, Emergency Room).
  • Some services subject to the annual deductible/co-insurance (Outpatient or inpatient services/ procedures). 
  • Behavioral health/Substance Abuse out-patient services first 20 visits covered at no cost, then $25 copay.
  • Diagnostic tests at a participating freestanding facility capped at $100 per test.
  • Annual basic eye exam at no cost at a participating optometrist.
  • Discount dental plan included at participating dental providers. 
  • NO OUT OF NETWORK COVERAGE (you are always covered when travelling for a medical emergency).
OPEN ACCESS
All of the County’s health plans are Open Access which means members do not select a Primary Care Physician (PCP) and NO referral is needed in order to see most network specialists. Members are encouraged (but not required) to see a primary care or family medicine physician for routine care. Physicians listed under the Primary Care and Family Medicine category on MyUhc.com have a lower copay/cost than physicians listed as a Specialist. Because it is not required that you obtain a referral to see a specialist, it is recommended you keep your primary/family physician up to date on any specialty care received so that all your personal health care information resides in one location.
EXCLUSIONS AND LIMITATIONS
All health plans have specific Exclusions and Limitations. Please contact the on-site UnitedHealthcare Reps for more information.
 
Pharmacy Info
2018 Formulary​
Formulary Exclusions​​
Pharmacy Benefits - CDH 2018
Your pharmacy benefits are provided under the County's self-insured pharmacy plan through OptumRx. Some of the plan features include:
    • an open formulary with five tiers of coverage at affordable copays,
    • a large network of participating pharmacies, 
    • a 90-day mandatory maintenance medication program (excludes specialty).

Consumer-Driven Health (CDH) Plans - 2018 Copay Rates

 
​Tiers ​30 Day Supply* ​90 Day Supply
Maintenance Medication
Generic​ ​$7 ​$14
Bra​nd-Preferred ​$30
​$60
Non-Preferred ​$45 ​$90
Specialty Pharmacy​ ​$75
​30 Day Supply Only
Dispense-as-Written (DAW1)​ & Excluded Drug ("Tried & Failed") ​$75 ​$150
 *Pharmacy can only fill a 30-day supply for maintenance medication 3 times before requiring a 90-day refill.
 
​Clinical Prior Authorization Program
Certain prescriptions require “clinical prior authorization,” or approval from your plan, before they will be covered. The categories/medications that require clinical prior authorization may include, but are not limited to: Acne (topical-after age 24), ADHD/Narcolepsy (after age 19), Botulinum Toxins, Lamisil/Sporanox, Obesity and Peniac. Upon receipt of a prescription falling into a covered category, Catamaran will contact your doctor’s office and request the documentation needed for Prior Authorization. 
To verify in advance, members may contact Catamaran/OptumRx​
Contact Info OptumRx
On-Site Reps: 954-357-7191 & 7192
Member Services: 1-855-356-3216
Specialty Pharmac​y
BriovaRx is Optum’s specialty pharmacy provider. They will assist members with their specialty medications to ensure safe and effective administration. BriovaRx provides free home delivery to your home/work address. Please contact Bri​ovaRx for more information regarding specialty pharmacy. 
Other Information:
Member Services: 855-427-4682
 
 
​​​​