Pennsylvania State University

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• Pennsylvania State University
• Medical Prescription
• Benefits 2008

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• No primary care physician designation required
• No referrals from primary care provider required
• Your choice
• In-network providers
• Out-of-network providers
• Covered anywhere with BlueCard
• World-wide coverage benefits

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Centre County Health Initiative (Centre County
Residents Only)

• Centre County Health Initiative Provider - 0
  co-pay
• Non-Centre County Health Initiative Provider -
  100 co-pay
• Copayment applies to
• Outpatient surgery
• Inpatient Admissions
• MRI, CT All Advanced imaging

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Centre County Health Initiative

• Copay will not be assessed for services from
• Mt. Nittany Medical Center
• Mt. Nittany Surgical Center
• Hershey Medical Center
• University Orthopedics
• Centre Medical Surgical Associates

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In-Network Benefits

• 0 deductible
• Copayments
• Primary care provider - 10
• Specialist - 15
• Emergency room - 50, waived if admitted
• 100 plan payment for services not requiring
  copayments
• No lifetime maximum

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Out-of-Network Benefits

• 500 individual deductible
• 1,000 family deductible
• 20 coinsurance
• Out-of-pocket maximum
• (2,000 individual/4,000 family)
• Lifetime maximum - 500,000 per person

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Providers Reasonable Charge

• In-Network 100 PRC
• In-network providers accept the PRC as payment in
  full
• Out-of-Network 80 PRC
• Highmark reimburses 80 PRC after out-of-network
  deductible
• Member responsible for difference between
  Highmark payment and providers charge

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Preventive Care

• Adult
• Physicals
• Annual gynecological/pap test
• Annual mammography
• Pediatric preventive care
• Exams
• Childhood immunizations
• Preventive schedule available on website

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Hearing Benefit

• Purchase of hearing aid device
• Audiometric testing
• 700 maximum every 36 months

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Prescription Drug Benefits

• Three tier incentive design
• One - generic
• Two - brand formulary
• Three - brand non-formulary
• Regardless of formulary status, access to all
  medications is available
• Diabetic supply copayments phased out

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Formulary Access

• One formulary
• Retail
• Medco mail order
• University Health Services (UHS)
• located in Ritenour Bldg
• www.highmarkblueshield.com Review Formulary!!!
• Dedicated PSU customer service 1-800-914-4384

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Retail Drug Benefit

• Retail pharmacies
• University Health Services (UHS)
• 30-day supply or less
• Generic 50 coinsurance
• Brand formulary 50 coinsurance
• Brand non-formulary 70 coinsurance

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Mail Order Drug Benefit

• Medco by Mail
• University Health Services (UHS)
• 90-day supply maintenance only
• Generic 20 coinsurance
• Brand formulary 20 coinsurance
• Brand non-formulary 70 coinsurance
• Allow 2 weeks for processing
• Medco free shipping
• UHS 3 mailing fee to non-campus addresses

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Mandatory Generic

• Member pays difference between generic and brand
  when generic is available (ancillary fee) unless
  medically necessary, as indicated on the
  prescription by your doctor

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Prescription Drug Benefits

• Out-of-pocket maximum
• 1,000 per member per year
• After OOP satisfied, coinsurance does not apply
• 50 and 70 member cost share included in
  calculation
• Excludes ancillary fee

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Specialty Medications

• Must be obtained through exclusive pharmacy
  provider, Medmark
• Examples multiple sclerosis arthritis
  medications
• Additional information available for those using
  specialty medications
• Medmark 1-866-240-8123

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Specialty Medications

• Formulary
• 50 coinsurance
• 50 maximum per prescription per month
• Non-formulary
• 70 coinsurance
• 100 maximum per prescription per month

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Tobacco Deterrents

• Prescription and over-the-counter covered
• Prescription from physician required
• 300 maximum per member per year

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Highmark Service Excellence

• Dedicated customer service
• 1-800-914-4384
• Hours
• 800 am 430 pm
• Monday through Friday
• Online access once enrolled
• www.highmarkblueshield.com
• 2040 Sandy Drive, State College location (near
  Science Park Road)

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Online Access Benefits

• www.highmarkblueshield.com
• Provider search pre-password
• Formulary search pre-password
• Drug pricing
• Expense summary
• Preventive schedule

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Contact Employee Benefits

• For more information see the Employee Benefits
  website
• www.ohr.psu.edu/benefits/benefits
• Call Employee Benefits, 814-865-1473
• E-mail Employee Benefits at benefits_at_psu.edu