The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
PHARMACY
Note: If you are enrolled in Kaiser Colorado, this information does not apply to you. Please see
the separate Kaiser materials.
Medco Health Solutions (Medco) is the Claims Administrator for the pharmacy benefits included
in the Early Retiree Medical, Comprehensive, Medica and UnitedHealthcare options. The
information stated throughout the entire “Pharmacy” section relates to all of these options (unless
otherwise noted).
Refer to the section “How Coverage Works If You Are Age 65 Or Older Or Pre-65 And
Medicare Eligible” in this SPD for information about Medicare Part D prescription drug
coverage.
You need to be sure to show your Medco ID card when receiving prescriptions and Medco will
track your claims for you. Once your combined pharmacy/medical deductible for the Early
Retiree Medical option or the pharmacy deductible for the Comprehensive, UnitedHealthcare
and Medica options has been satisfied you will only be charged the applicable copayment or
coinsurance for eligible prescriptions, until you reach your combined pharmacy/medical out-ofpocket
maximum for the Early Retiree Medical option and the pharmacy out-of-pocket
maximum for the Comprehensive, UnitedHealthcare and Medica options.
Coverage includes two prescription drug-dispensing methods:
• Mail order using the Medco Pharmacy or Accredo (a division of the Medco Pharmacy
for specialty drugs); and
• Retail Pharmacy.
Pharmacy Deductibles, Coinsurance and Maximums
Note: This section only applies to you if you are enrolled in the Comprehensive, Medica or
UnitedHealthcare options. If you are enrolled in the Early Retiree Medical option see the
“Deductibles, Coinsurance and Maximums” section in this SPD, for information on the
combined medical/pharmacy deductibles, coinsurance and maximums.
Deductible
A deductible is the per plan year amount you must pay toward eligible expenses before you and
the health care option begin to share covered expenses. The deductible is applied to the out-ofpocket
maximum. The deductible for the Comprehensive, UnitedHealthcare and Medica options
is an embedded deductible. Under the health care and pharmacy care options, there are two
different types of deductibles. They are: pharmacy and medical deductible. For a definition of
each of these deductibles, refer to the “Glossary of Terms” section in this SPD.
Deductibles are designed as per person and per family (i.e., the Retail Pharmacy deductible is
$250 per person or $750 per family). Family deductibles apply to a participant with two or more
covered dependents. If you have selected Family coverage but have only one covered dependent,
you and the dependent will each be responsible for the per person deductible.
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