Embed Size (px)
Citation preview
0…
Annual Enrollment
For employees covered by a collective bargaining agreement ratified in 2014, or 2013 for Pratt & Whitney Connecticut
HDHP with HSA Frequently Asked Questions 2015
This is a resource to help answer your questions regarding the HDHP with HSA. Simply click on a section or question to be taken directly to the answer you’re researching.
Inside
HDHP with HSA: The Basics of the Plan .................................................................................. 3
1. What is the High Deductible Health Plan with Health Savings Account (HDHP with HSA)? ................................................................................................................................... 3
2. What are the differences between the HDHP with HSA and the other medical plans available to me? .................................................................................................................... 3
3. I’ve heard that it’s risky to enroll in the HDHP with HSA because the deductible is so high. Is that true? .................................................................................................................. 4
4. It seems like UTC is encouraging employees to enroll in the HDHP with HSA. Why? ............. 4
5. I’m currently enrolled in a BYO plan but I’m considering the HDHP with HSA for 2015. Is there someone I can call to help answer my questions? ........................................... 4
6. How can I estimate how much I’ll spend on health care expenses if I enroll in the HDHP with HSA? .................................................................................................................. 5
Health Savings Account: The Basics of the Account .............................................................. 6
7. What is a Health Savings Account (HSA)? ............................................................................ 6
8. What’s the difference between an HSA and a Health Care Spending Account (HCSA)? ............................................................................................................................... 6
9. I’ve heard that the HSA has a triple tax advantage. What does that mean?............................ 6
How the HDHP with HSA Works ............................................................................................... 7
10. How do I pay for care if I am enrolled in an HDHP? ............................................................... 7
11. Who administers the HDHP with HSA? How can I contact them? .......................................... 7
12. How do the family deductible and the medical out-of-pocket maximum work for the HDHP with HSA? .................................................................................................................. 7
13. Am I locked into the HDHP with HSA for all future years once I join and decide to contribute money to the HSA? ............................................................................................... 7
2
Opening an HSA ........................................................................................................................ 8
14. How do I sign up for an HSA? ............................................................................................... 8
15. Do I have to use PayFlex to open my HSA? .......................................................................... 8
Contributing to an HSA ............................................................................................................. 8
16. When and how can I elect the amount I want to contribute per pay period to the HSA? Can I change this amount during the year? ................................................................. 8
17. What are the minimum and maximum amounts that I can contribute to my HSA? .................. 9
18. Will my HSA contribution amounts roll over to 2015? ............................................................. 9
19. How do I determine how much to contribute to the HSA? .................................................... 10
20. Can I contribute to both an HCSA and HSA at the same time? ............................................ 10
Using an HSA .......................................................................................................................... 10
21. How do I use the HSA to pay for eligible health care expenses? .......................................... 10
22. What can I use the HSA funds for? ...................................................................................... 11
23. Do I have to use the funds in the HSA by a certain time each year (i.e., does “use it or lose it” apply)? ................................................................................................................ 11
24. If I participate in the HDHP with HSA for one year, and then I switch to another plan or leave UTC, what happens to the balance in my HSA? ..................................................... 11
25. After I retire, can I still use the money in my HSA? If so, can I use it to pay for retiree medical contributions? ........................................................................................................ 11
26. What happens to the money in my HSA if I die? .................................................................. 11
Prescription Drug Coverage With CVS Caremark .................................................................. 12
27. How does prescription drug coverage work with the HDHP with HSA? ................................ 12
28. Why did UTC choose CVS Caremark to administer prescription drug benefits? ................... 12
29. When should we begin to use CVS Caremark? ................................................................... 12
30. Will I receive a new ID card? ............................................................................................... 13
31. What should I do about a refill scheduled for pick-up in January? ........................................ 13
32. How do I find a participating pharmacy? .............................................................................. 13
33. What happens if my doctor or I specifically request a brand-name drug under the HDHP plan when a generic equivalent is available? ............................................................ 13
34. How will my current mail-order drug refills transfer to CVS Caremark?................................. 13
35. How do I get started using CVS Caremark by Mail after January 1, 2015? ......................... 13
36. How can I find out if my prescription is classified as a maintenance medication so I can use CVS Caremark by Mail? ......................................................................................... 14
37. How soon will I receive my CVS Caremark by Mail prescription? ......................................... 14
38. Why did I receive a mail-order prescription drug that is different from the one my doctor prescribed? .............................................................................................................. 14
39. Are there different tiers of prescription drugs under the HDHP with HSA? ............................ 14
HDHP with HSA
3
HDHP with HSA: The Basics of the Plan
1. What is the High Deductible Health Plan with Health Savings Account (HDHP with HSA)?
The HDHP with HSA offers the same valuable coverage as other types
of medical plans, but is made up of two components:
The HDHP, which provides medical, prescription drug and mental health/substance abuse coverage, and
The HSA, which is an interest-bearing account that allows you to build savings for future health care costs (such as in retirement), as well as offset current health care costs.
The best way to learn about this plan and how an HSA works is to watch
the HDHP with HSA video on Your Gateway.
2. What are the differences between the HDHP with HSA and the other medical plans available to me?
Like other types of medical plans, the HDHP with HSA provides
comprehensive coverage, but it also promotes healthy behaviors and
saving for the future. Not only does it cost you less out of your paycheck
than any other medical option offered by UTC, but it’s also the only plan
that allows you access to a Health Savings Account (HSA), so you can
save tax-free money for future health care expenses.
To learn more about the HDHP with HSA, consider one of the following
resources on Your Gateway:
Use the Health Plan Comparison Chart and select up to three health care plans to see how costs and coverage compare.
Watch these informative videos that dive deeper into how the plans work:
HDHP with HSA
Understanding My Annual Medical Costs, which explains the key
components that make up your annual medical costs under
different types of medical plans (i.e., your paycheck
contributions, copays, deductible, coinsurance and out-of-pocket
maximum)
Saving for the Future, which is a comparison of the Health
Savings Account and the Health Care Spending Account
HDHP with HSA
4
3. I’ve heard that it’s risky to enroll in the HDHP with HSA because the deductible is so high. Is that true?
On the surface the deductible seems high, but the reality is that you
save money in paycheck contributions and can instead use those funds
toward any actual health care services you receive.
The medical out-of-pocket maximum is your safety net — it’s the most
money you would have to pay for health care services in a calendar year
after you meet your deductible. After that, UTC pays 100% of the cost of
covered health care expenses for the rest of the year. Plus, if you take
certain preventive medications, you don’t need to meet the deductible if
you buy generic equivalents. You only need to pay coinsurance, which
will mean lower out-of-pocket costs. Go to Your Gateway for the
preventive drug list.
Keep in mind, you also can find added savings if you contribute tax-free
dollars to an HSA and use those funds to pay for eligible health care
expenses now or in the future.
4. It seems like UTC is encouraging employees to enroll in the HDHP with HSA. Why?
High deductible health plans are a good fit for UTC employees and the company. Why? HDHPs save you money and they give you a better way to save for future health care expenses.
The deductibles for the HDHP are higher than the deductibles you have
in other UTC-sponsored plans. However, the higher deductible is
balanced by the much lower paycheck contributions. The HDHP also
has a medical out-of-pocket maximum which puts a cap on how much
you have to pay for eligible medical services and prescription drugs for
the year. All of these things add up to lower total out-of-pocket costs.
Plus, the HDHP with HSA helps participants plan for health care
expenses in the future, including in retirement, by saving tax-free money
in an HSA. And since the HDHP with HSA has lower contributions than
other types of medical plans, you can save money in your paycheck and
instead contribute those funds to your HSA to use toward any actual
health care services you receive.
5. I’m currently enrolled in a BYO plan but I’m considering the HDHP with HSA for 2015. Is there someone I can call to help answer my questions?
Benefits Advocates can provide additional information about
transitioning from a BYO plan to an HDHP with HSA plan. They are
available to answer your questions and point you toward additional
resources available on Your Gateway. To reach a Benefits Advocate,
call AccessDirect at 1-800-243-8135. From the main menu, follow the
prompts for Annual Enrollment. Advocates are available from 8:30 a.m.
to 8:00 p.m. ET, Monday through Friday.
HDHP with HSA
5
6. How can I estimate how much I’ll spend on health care expenses if I enroll in the HDHP with HSA?
To estimate what you might spend on health care next year, try using
the Medical Expense Estimator available on Your Gateway. This tool
helps you project what your medical expenses will be in 2015 (including
paycheck contributions and out-of-pocket costs) by using your utilization
history*. You can also adjust the tool to reflect the services you and your
family expect to use in 2015. And, if you’re not sure how to use the
Medical Expense Estimator, check out the How to Use the Medical
Expense Estimator video for a quick demo.
You can also take advantage of the Health Care Cost Summary to help
you get a clearer picture of your total health care expenses. The tool
shows what you’ve spent, including paycheck contributions and actual
out-of-pocket health care costs*. Use this information to think about your
coverage options for 2015 and to make sure you are putting enough
money into your Health Savings Account (HSA).
* If you're enrolled in a UTC-sponsored medical plan, up to 18 months of utilization/claims history is available (January 1, 2013, through June 30, 2014). Your history is not available
in these tools if you are enrolled in Kaiser, MVP, HMSA Hawaii or a medical plan not sponsored by UTC, or if you are an expatriate.
HDHP with HSA
6
Health Savings Account: The Basics of the Account
7. What is a Health Savings Account (HSA)?
A Health Savings Account is an account that you can use for eligible
health care expenses. You can contribute tax-free dollars to this account
from your paycheck to pay for health care expenses now, or you can use
it for future health care expenses. Your HSA contributions are yours to
keep — even if you leave UTC. To learn more about the HSA, watch the
HDHP with HSA video on Your Gateway.
8. What’s the difference between an HSA and a Health Care Spending Account (HCSA)?
The simple difference stems from the “S” in each account.
The HCSA is a “spending” account, meaning that dollars you don’t spend by the end of the plan year are forfeited.
The HSA is a “savings” account, so money contributed rolls over year to year and grows with tax-free interest, but is accessible for any eligible health care expense you have now. In addition, the money in your HSA is yours even if you retire or leave UTC and, once your balance reaches $1,000, amounts over $1,000 can be invested. Also, the IRS annual contribution limit to an HSA is higher than the annual contribution limit to an HCSA.
If you enroll in the HDHP with HSA, you are eligible to open a Health
Savings Account (HSA). If you enroll in another UTC plan or elect “no
medical coverage,” you cannot open an HSA and are only eligible to
open a Health Care Spending Account (HCSA).
For more information about how the HSA and HCSA differ, refer to the
Saving for the Future: Comparing the HSA to the HCSA I-Cast on
Your Gateway.
9. I’ve heard that the HSA has a triple tax advantage. What does that mean?
The HSA allows you to build savings for the future through a triple tax
advantage. Your money is tax-free going in, as it earns income and as
you spend it for qualified expenses. And, if you need it today for health
care expenses, it’s there for you with no tax penalty.
HDHP with HSA
7
How the HDHP with HSA Works
10. How do I pay for care if I am enrolled in an HDHP?
When you receive care, you can pay for the service directly out of your
pocket or use the funds in your HSA. You will need to meet a deductible
before the plan pays its share of health care costs (including prescription
drugs). Note: The deductible will be waived for certain preventive care
services and preventive generic medications under the HDHP with HSA
plans.
After you meet your deductible, UTC pays 80% of the cost for additional
health care expenses — as long as you stay in network — and you pay
20% (this is called coinsurance).
If you have significant health care expenses and stay in network, you
may reach your out-of-pocket maximum. This is the most you pay out of
your pocket. After that, UTC pays 100% of your in-network costs for the
rest of the plan year.
11. Who administers the HDHP with HSA? How can I contact them?
Health plan vendors vary by your home ZIP code. Please refer to Your
Gateway to find the health plan vendors that are available to you.
PayFlex is our HSA administrator. For more information about PayFlex,
watch the Your Health Savings Account video on Your Gateway.
12. How do the family deductible and the medical out-of-pocket maximum work for the HDHP with HSA?
For family coverage, there are no individual limits for the deductible or
medical out-of-pocket maximum. This means that you must meet the
family deductible before the plan starts paying anything toward your
medical expenses, and you will continue to pay coinsurance until you
meet the family medical out-of-pocket maximum.
13. Am I locked into the HDHP with HSA for all future years once I join and decide to contribute money to the HSA?
No. If you elect the HDHP with HSA, it will be your coverage for 2015,
but you are not obligated to choose it in 2016 or beyond. But remember
in future years, you must actively change your coverage if you don’t
want the HDHP anymore. Otherwise, you will default into your current
coverage, unless it is no longer available.
Please note that you must be enrolled in the HDHP with HSA to make
contributions to an HSA. UTC will cover the monthly account
maintenance fee if your HSA is with PayFlex and you are enrolled in the
HDHP. If you are no longer enrolled in the HDHP with HSA, you may
continue to use any money in your HSA account to help pay for eligible
health care expenses. However, UTC will not pay the monthly account
maintenance fee. Any fees will automatically be deducted from your
account balance.
HDHP with HSA
8
Opening an HSA
14. How do I sign up for an HSA?
You may open an HSA with PayFlex — UTC’s HSA administrator — or
with any financial institution that offers an HSA. However, UTC payroll
will only be able to deduct pre-tax contributions from your paycheck for
deposit into your HSA if you use PayFlex. Additionally, if you use
PayFlex for your HSA, UTC will pay the basic monthly account
administration fee while you are enrolled in the HDHP.
You can enroll in an HSA with PayFlex from Your Gateway during
Annual Enrollment. After you set your goal amount on Your Gateway,
PayFlex may request you to provide more information before opening
your HSA, such as your address or date of birth. PayFlex may also ask
for copies of your identifying documents. Simply follow the instructions
PayFlex provides to continue setting up your HSA.
15. Do I have to use PayFlex to open my HSA?
No. However, if you choose to use an HSA administrator other than
PayFlex, you will need to deposit money directly into your HSA. Those
contributions will be made with after-tax money and you will have to
claim them on your individual tax return for tax-favored treatment. You
will also be required to pay any applicable administration fees.
Contributing to an HSA
16. When and how can I elect the amount I want to contribute per pay period to the HSA? Can I change this amount during the year?
If you elect the HDHP with HSA when you enroll on Your Gateway, you
will be prompted to enter the total amount you’d like to contribute to your
HSA.
To have money deducted from your paycheck and sent to your HSA,
you must open the HSA through PayFlex — UTC’s HSA administrator.
Any health care claims incurred before you set up your account are not
eligible to be reimbursed from your HSA. Therefore, you should be sure
to open your HSA as part of your Annual Enrollment process.
If, during the year, you need to change the amount you are contributing,
you can do so online through Your Gateway.
HDHP with HSA
9
17. What are the minimum and maximum amounts that I can contribute to my HSA?
The IRS limits how much you can contribute to an HSA in a year, and
you have to be enrolled in an HDHP with HSA option to make
contributions to an HSA.
Here are the HSA contribution limits for 2015:
$3,350 if you elect you-only coverage
$6,650 if you elect coverage for you and your family
Also, once you reach age 55, and each year thereafter, you are eligible
to make an additional annual tax-free "catch-up" contribution of up to
$1,000 to your HSA for that year. There are no minimum contribution
amounts.
You should contribute as much as you can to your HSA. After all, the
HSA is the only savings vehicle that allows you to build savings for the
future through a triple tax advantage, which includes tax-free
contributions, earnings and withdrawals. Plus, if you don’t use the
money this year, your account balance rolls over to help save for
expenses next year or in the future (including in retirement).
Note: Before you max out your HSA, be sure you’re contributing enough
to your Savings Plan account to get the full company match. If you are
not contributing enough to your Savings Plan to get the full company
match, you are missing out on free money from UTC. Need help
determining the best ways to save? Use HelloWallet, a free service from
UTC, to help you plan for your financial wellness.
18. Will my HSA contribution amounts roll over to 2015?
Yes. Your 2015 HSA election will default to your current HSA goal
amount if you do not actively change it for 2015. You must update your
goal amount if you wish to contribute the new maximum amount allowed
for 2015 (up to $3,350 if you have you-only coverage, or up to $6,650 if
you have coverage for you and your family).
HDHP with HSA
10
19. How do I determine how much to contribute to the HSA?
You can use the modeling tool called “Estimate Your Health Savings
Account Expenses” under the “Use the tools to model next year”
enrollment step on Your Gateway to help estimate your eligible
expenses for the upcoming year.
You can also use the “Project Your Health Savings Account (HSA)
Growth Potential” modeling tool to see how your tax-advantaged HSA
balance can grow over time with tax-free earnings, providing you with
tax-free savings for future eligible health care expenses.
Remember that the best advantage of the Health Savings Account is
that your balance rolls over from year to year, allowing you to save for
the future. For this reason, it makes sense to set aside as much as you
can.
You can also use the Health Care Cost Summary* to help you get a
better picture of your total health care expenses. It shows what you’ve
spent, including your paycheck contributions and your actual out-of-
pocket health care costs. You can use your out-of-pocket health care
costs to help make sure you are saving enough in your Health Savings
Account (HSA) or Health Care Spending Account (HCSA). You can find
the Health Care Cost Summary in the “Compare your plan options”
enrollment step on Your Gateway.
* If you're enrolled in a UTC-sponsored medical plan, up to 18 months of utilization/claims history is available (January 1, 2013, through June 30, 2014). Your history is not available
in these tools if you are enrolled in Kaiser, MVP, HMSA Hawaii or a medical plan not sponsored by UTC, or if you are an expatriate.
20. Can I contribute to both an HCSA and HSA at the same time?
No. The IRS does not permit you to contribute to both an HSA and an
HCSA (and since both accounts cover the same eligible expenses, there
would be no reason to contribute to both).
If you are currently participating in the HCSA in 2014 and will be
enrolling in the HDHP for 2015, you will not be able to have an HCSA
next year. Instead, for 2015 you will want to open an HSA – a triple tax
advantaged account that allows you to save for medical expenses now
and in the future.
Using an HSA
21. How do I use the HSA to pay for eligible health care expenses?
Your HSA allows you to pay for services using your HSA debit card or
online through PayFlex. You can also pay out of pocket at the time of
service and submit a claim for reimbursement. Or, you can choose to
pay out of pocket and keep growing your HSA balance to pay for future
medical expenses. But, don’t forget, you can only spend HSA funds that
are actually in the account.
HDHP with HSA
11
22. What can I use the HSA funds for?
You can use the funds in your HSA to pay for eligible medical, dental
and vision expenses, including office visits, prescription medications,
orthodontia and contact lenses. You cannot use the funds in your HSA
to pay your monthly paycheck contributions (unless you are retired) or
for over-the-counter drugs (unless you have a prescription).
The same types of eligible medical, dental and vision expenses that can
be reimbursed from the HCSA are eligible to be paid with your HSA.
23. Do I have to use the funds in the HSA by a certain time each year (i.e., does “use it or lose it” apply)?
No. There is no “use it or lose it” rule with an HSA. Any unused funds in
your account roll over from year to year. You can continue to use the
money in the HSA for health care expenses in future years, even if you
leave UTC. The funds in your HSA are yours to keep.
24. If I participate in the HDHP with HSA for one year, and then I switch to another plan or leave UTC, what happens to the balance in my HSA?
The HSA is a separate account that you set up with a financial
institution. If you stop participating in the HDHP with HSA or leave UTC,
the account (and any money in it) is still yours.
If you are no longer enrolled in the HDHP and wish to keep your account
open, you will become responsible for paying the monthly fees. Fees
may include an account administration fee and account investment fee.
You can also roll over your HSA balance to your new employer's HSA (if
available) or to one you set up independently. Each financial institution
has different requirements when it comes to minimum balances, so
make sure you gather all the facts.
25. After I retire, can I still use the money in my HSA? If so, can I use it to pay for retiree medical contributions?
Yes. The HSA is designed to allow you to save for future health care
expenses, including in retirement. You have the option of using money in
your HSA to pay for eligible services today, or paying for the services out
of your pocket and saving the money in your HSA for the future.
When you retire, you may use the money in your HSA to offset retiree
medical expenses, eligible health care expenses and certain other
contributions, including insurance premiums (other than premiums for
Medicare supplemental policies, such as Medigap) if you’re 65 or older.
26. What happens to the money in my HSA if I die?
You designate a beneficiary when you set up your HSA. If your spouse
is your designated beneficiary, the HSA will be treated as your spouse’s
HSA after your death. If your spouse is not the designated beneficiary,
the account stops being an HSA and the fair market value of the HSA
becomes taxable to the beneficiary in the year that you die.
HDHP with HSA
12
Prescription Drug Coverage With CVS Caremark
27. How does prescription drug coverage work with the HDHP with HSA?
Prescription drug coverage for the HDHP with HSA is administered by
CVS Caremark. Under the HDHP with HSA, prescription drug expenses
count toward your annual deductible and medical out-of-pocket
maximum. This means that you will pay the full cost of your prescriptions
until you meet your plan’s annual deductible, except for certain
preventive generic medications, which the plan begins to pay for before
you meet your deductible.
After you meet your deductible, you will pay coinsurance for your
prescription drugs until your medical coinsurance maximum is reached.
Then the plan will pay 100% of the cost.
There are two things to keep in mind:
Using preventive generic drugs will help you manage your costs.
You do not have to meet the annual deductible if you take generic equivalents for certain preventive medications. If so, you are only responsible for coinsurance amounts.
When you purchase prescription drugs, you should show your CVS
Caremark ID card. You can fill a one-month supply at a retail pharmacy
or up to a 90-day supply (of a maintenance medication) through mail
order or for pickup at a local CVS pharmacy.
28. Why did UTC choose CVS Caremark to administer prescription drug benefits?
UTC selected CVS Caremark because they are an industry leader and
one of the most experienced pharmacy benefits managers in the nation.
Their strengths include:
A network of over 64,000 pharmacies nationwide,
Convenient mail-service pharmacies for easy ordering of refills,
The option to pick up 90-day maintenance drugs at a CVS pharmacy,
A full complement of Internet services, sophisticated drug use checks and balances, and
A 24-hour clinical hotline and well-trained member service representatives.
29. When should we begin to use CVS Caremark?
You should start using CVS Caremark for your prescription drug
coverage needs the first time you need a prescription filled in 2015. That
means you should stop using your current prescription ID card for your
prescription drug needs as of January 1, 2015. During late-December
2014, you will receive a CVS Caremark Welcome Kit explaining your
new prescription drug program.
UTC is making every effort to have your current mail-order prescriptions
automatically transferred to CVS Caremark. However, that may not be
able to happen in all cases. That’s why it’s a good idea to request a new
maintenance medication prescription from your doctor before the end of
the year in case it’s needed. Also, please note that prescriptions for
certain controlled substances and compound medications cannot be
transferred and will require a new prescription.
HDHP with HSA
13
30. Will I receive a new ID card?
Yes, your CVS Caremark Welcome Kit will include an ID card(s) for your
prescription drug plan. You will also receive a new ID card(s) from your
medical plan vendor separately. Upon receipt of your new ID card(s),
please destroy your old card(s), as they are no longer valid and cannot
be used.
31. What should I do about a refill scheduled for pick-up in January?
You do not need to get new prescriptions from your physician to get or
refill your prescription drugs. Beginning January 1, 2015, you will simply
need to provide your new CVS Caremark ID card to your retail pharmacy
and tell them you have a new pharmacy benefits administrator. Your
retail pharmacy will then process your prescription drug claim with CVS
Caremark. Mail-order refills are handled differently and are discussed
later in this communication.
If possible, it is strongly suggested that you obtain any refills prior
to the transition. It is important to plan ahead to avoid running out
of important medication.
32. How do I find a participating pharmacy?
You can locate participating retail pharmacies by calling CVS Caremark
at 1-800-897-6435 beginning December 15, 2014, or online at
www.caremark.com after January 1, 2015.
33. What happens if my doctor or I specifically request a brand-name drug under the HDHP plan when a generic equivalent is available?
If your doctor prescribes a brand-name drug when a generic equivalent
is available, you must pay the generic coinsurance plus the difference in
cost. This applies even if your doctor indicates “no substitutions” on your
prescription.
Under the HDHP, the cost difference won’t count toward your deductible
or medical out-of-pocket maximum.
34. How will my current mail-order drug refills transfer to CVS Caremark?
UTC is making every effort to have your current mail-order prescriptions
automatically transferred to CVS Caremark. However, that may not be
able to happen in all cases. That’s why it’s a good idea to request a new
maintenance medication prescription from your doctor before the end of
the year in case it’s needed.
Contact CVS Caremark at 1-800-897-6435 after January 1, 2015, to find
out if your mail-order prescriptions were able to be transferred.
You will not be able to order refills until after January 1, 2015. Also,
please note that prescriptions for certain controlled substances and
compound medications cannot be transferred and will require a new
prescription.
35. How do I get started using CVS Caremark by Mail after January 1, 2015?
Let your doctor know that your plan offers a mail-order service, and ask for a prescription for the maximum days’ supply of medication (usually 90 days) plus refills for up to one year.
You may mail your prescriptions directly to CVS Caremark, or call the FastStart line at 1-800-875-0867 after January 1, 2015.
HDHP with HSA
14
36. How can I find out if my prescription is classified as a maintenance medication so I can use CVS Caremark by Mail?
To confirm whether your prescription is classified as a maintenance
medication, call CVS Caremark at 1-800-897-6435. Additionally, after
several refills of your drug at a retail pharmacy like your local CVS
pharmacy, you will receive a letter at home indicating that your
medication is a maintenance medication and that you should consider
switching to mail-order. This letter will also provide instructions on
switching.
Please note that under a BYO Plan your prescription drug cost will
double if you use retail for more than 90 days for maintenance drugs.
37. How soon will I receive my CVS Caremark by Mail prescription?
For first-time orders, you can expect to receive your prescription within
10–14 days. If your prescription is faxed or submitted online by your
physician, turnaround times are usually faster. Once you have filled your
prescription through CVS Caremark by Mail, you may have the
opportunity to sign up for automatic refills/automatic renewals. For more
information on your specific prescriptions, please visit
www.caremark.com after January 1, 2015.
38. Why did I receive a mail-order prescription drug that is different from the one my doctor prescribed?
Through a sophisticated system used to process each prescription, CVS
Caremark identifies opportunities to provide you with a lower-cost
medication that is of the same strength and effectiveness as the
medication prescribed by your doctor. Such opportunities include:
Switching a brand-name drug to a lower-cost generic alternative,
Switching a non-preferred drug to a preferred (formulary) drug, and
Switching from one brand to another.
Your doctor must approve all medication substitutions (except for
generics in the state of Massachusetts). CVS Caremark pharmacists will
proactively contact your doctor to discuss the therapeutically equivalent
alternative and obtain his or her approval before the prescription is
changed. A confirmation letter is sent to you and your doctor, along with
the alternative prescription.
39. Are there different tiers of prescription drugs under the HDHP with HSA?
Yes. There are different tiers of prescription drugs under the HDHP with
HSA. The tiers are generic, preferred brand-name and non-preferred
brand-name. To learn more about the tiers, and to look up the
formularies — the pre-approved list of preferred brand-name drugs — go
to Your Gateway.
These FAQs provide an overview of benefits effective January 1, 2015. If there is any discrepancy between these FAQs and the official plan documents, the
official plan documents will govern.
