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BenefitsPlansUHC CDH / Optum Rx
UHC and OptumRx

UHC CDH & Optum Rx

When you choose UnitedHealthcare with Optum Rx, you will have access to programs that empower you to make more informed health decisions and support to help you reach your own health and wellness goals.

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What is New for 2020
Health & Pharmacy

​Health Plan - UHC CDH Plan​

No changes to CDH High Plan premium, plan design, deductibles, coinsurance, copays, and out-of-pocket.

New for 2020

  • Bariatric Program – implementation of a full bariatric program through UHC and CCP. If approved for surgery, a separate $4,500 deductible applies.
  • Orthopedic Health Support program – through UHC providing a single point of contact from early pain through surgery.

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 covered when traveling for a true 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.
The chart below is summary of coverage, for more details go to MyUHC.com:

 

​​BENEFIT  UHC CDH National Network
Annual Deductible*​ ​$1,300 Single, $2,600 Dependents 
(Does not include Rx)
​Annual Coinsurance @ 20%* ​$1,500 Single, $3,000 Dependents
​Annual Max Out of Pocket* ​$2,800 Single, $5,600 Dependents
​Preventive Care ​No Cost when billed as Preventive Care 
by Provider
​Primary Care Doctor ​$25 copay
​Specialist​ ​$50 copay
​Lab Work ​No cost at Lab Corp or Quest
​Virtual Visits (Telehealth) ​$50 copay
​Urgent Care -National Network ​$50 copay
​Emergency Room ​$250 copay
​MRI/Nuclear Medicine ​20% up to a $100 max, at 
Freestanding Facility​
​Behavioral Health/Substance 
Abuse Out Patient visits
​No cost for first 20 visits, $25 copay 
per visit thereafter. Requires a referral prior to 1st visit
​All other medical services ​Subject to Annual Deductible and 
20% Coinsurance
​Rx copays OptumRx ​Generic:  $7.00-30-day / $14.00-90-day
Preferred: $25.00-30-day / $50.00-90-day
Non-Preferred: $45.00-30-day / $90.00-90-day
Specialty: $75.00 30-day Only
​Plan includes the following benefits:​ ​Basic annual eye exam
Discount Dental Plan​
​*Does not include pharmacy copays
Contact Info:
UHC Member Services: 1-866-873-3903
On-Site Rep 954-357-7191 or 7192
​​​​​​​​

​Pharmacy - Optum Rx - CDH

Your pharmacy benefits are provided under the County's self-insured pharmacy plan through OptumRx. Some of the plan features include: 
  • a​n open formulary with five tiers of coverage at affordable co-pays, 
  • a large network of participating pharmacies,
  • a 90-day mandatory maintenance medication program (excludes specialty).​ ​
Consumer-Driven Health (CDH) Rx Plans - 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.
 

Plan​ 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. 

UPDATE: 
Pharmacy Plan (UHC and CCP) - Specialty Drugs Only: HDHP Plans: Manufacturer copay/financial assistance is a great benefit to help pay for costly Specialty drugs. In the past, manufacturer assistance was applied outside of the plan and the actual cost paid by the member was not accurately applied to their annual health deductible and coinsurance accumulators. This was an unintended benefit due to pharmacy systems not being able to apply the manufacturer assistance first.  Effective January 1st, 2020, members using Specialty drugs through OptumRx (Briova) (UHC) or Southern Scripts (CCP) will have the manufacturer assistance applied up front and only the actual amount a member pays out of pocket will be applied to their annual deductible or coinsurance accumulators.  Member will continue to receive the same financial assistance from the manufacturer; however, that assistance will now be incorporated into the member’s health deductible and coinsurance.
 
Contact Info:
OptumRx
Member Services: 1-855-356-3216​
On-Site Reps: 954-357-7191 & 7192


 
Specialty Pharmac​y

OptumRx 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. 
 
Contact Info:​​
Optum Rx
​Me​mber Services: 855-427-4682