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BenefitsPlansUHC HDHPs and Optum Rx
UHC and OptimRx

UHC HDHPs & Optum Rx

When you choose UnitedHealthcare with Optum Rx, you'll 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 HDHP Plans

  • The deductible for the HDHP Choice Base is $1,400 EE and $2,800 EE+Dependents.
  • The deductible for the HDHP Choice plus In & Out of Network is $1,500 EE and $3,000 EE+Dependents.
The County is funding the deductible for HDHP Base plan upon completion of the Engagement Incentive with $1,200 for EE and $2,400 for EE+Dependent. The funding for the HDHP Choice plus In & Out of Network is the same as the HDHP Base amount $1,200 EE and $2,400 EE+Dependents.

NEW for 2020
  • Bariatric Program – implementation of a full bariatric program through UHC. 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.

Hig​hlights of HDHP's 
  • All health and prescription services are subject to the annual deductible and coinsurance based on tier of coverage with the exception of mandated preventive services or designated preventive prescriptions (see Preventive Rx list​).
  • Medical and prescription expenses will be applied toward meeting the annual deductible and coinsurance amount based on tier of coverage (Member Only coverage or Member + Dependents coverage).
  • Once the annual deductible is met, the health and pharmacy plan pays 80% and you pay 20% coinsurance of the eligible discounted costs (in-network).
  • When you reach the out-of-pocket maximum, the Plan pays 100% of eligible in-network health and prescription expenses.
  • Preventive services (see Complete Summary book​) and designated preventive prescriptions are covered at 100%.
  • Annual eye exam at no cost at a participating optometrist.
  • Discount dental plan included at participating dental providers​.
EXCLUSIONS AND LIMITATIONS
All health plans have specific Exclusions and Limitations. Please contact the on-site UnitedHealthcare Reps for more information.

​Additional Programs:
RALLY Program -Employer Rewards
Real Appeal - Lifestyle Weight loss

​Contact Info:​
UHC Member Services: 1-866-873-3903
​On-Site Rep 954-357-7191 or 7192
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​​Pharmacy - Optum Rx

Your pharmacy benefits are provided under the County's self-insured pharmacy plan through OptumRx. Some of the plan features include: a large network of participating pharmacies and a 90-day mandatory maintenance medication program (excludes specialty).​ 

Non-Preventive Prescription Drugs
  1. ​The discounted drug cost is applied to the deductible.
  2. After the annual health deductible is met, the plan pays 80% and the member pays 20% coinsurance of the discounted drug cost.
  3. 100% Coverage after the annual health out-of​-pocket is met; prescription drugs are paid in full by the plan.​
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 upfront 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.

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 OptumRx​.
Frequently Asked Questions - Prior Authorization Program​

Contact Info:
Optum Rx Member Services: 1-855-356-3216​​
S​pecialty Pharmacy
OptumRx is the 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 BriovaRx for more information regarding specialty pharmacy.

OptumRx Contact Info:
For Rx Call: 1-855-427-4682
For Other Info Call: 1-855-577-6521



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