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|CoreSource (medical plan administrator)||How do I find out if my healthcare provider is in our network?|
|Select PPO and Choice PPO||Prescription Drug Coverage|
|Coverage Levels (Tiers)||Priority for generics|
|Monthly Premiums||31-day supply limit at local pharmacy (retail)|
|Preventive Care||Caremark FastStart program|
|Medical Plan and Prescription Drug ID Cards||Flexible Spending Account (FSA)|
Whether you are sick or injured, your medical coverage is one of your most valuable benefits. St. Jude pays a major portion of the expenses for your medical coverage through the Select PPO and Choice PPO options. CoreSource and Caremark administer the medical and prescription drug plans, respectively.
While both plans have the same covered services and feature in-network and out-of-network coverage, the main differences are the cost structures of the plans. The PPO plans have different deductibles, out-of-pocket maximums and premiums; giving you the opportunity to select a plan based on how you and your family use your medical benefits. That is, you choose when and how you want to pay for your health care costs.
For medical coverage, you can choose from six levels (tiers) of coverage or waive coverage:
|Medical Coverage Level||Who’s covered|
|Employee Only||Yourself only|
|Employee + Child(ren)||Yourself and your child(ren)|
|Employee + Spouse||Yourself and your spouse|
|Employee + Spouse + Child(ren)||Yourself, your spouse and your children|
|Employee + SGP||Yourself and your same gender domestic partner|
|Employee/Child(ren) + SGP||Yourself, your child(ren) and your same gender domestic partner|
You and St. Jude Children’s Research Hospital share the costs of your medical coverage; St. Jude pays approximately 80%. Your premiums are deducted from 24 paychecks per year on a pre-tax basis. When you pay with pre-tax dollars, you receive a tax break because the money is deducted before federal income taxes and Social Security taxes. The table below shows your monthly contributions if you choose coverage under the plans. The annual costs for the benefit options vary depending on the plans and coverage levels (tiers) you choose.
||Monthly COBRA Rates1|
|Employee + Child(ren)||$146||$292||$1,060|
|Employee + Spouse||$194||$388||$1,333|
|Employee + Spouse + Child(ren)||$232||$464||$1,774|
|Employee + Child(ren)||$73||$146||$979|
|Employee + Spouse||$97||$194||$1,236|
|Employee + Spouse + Child(ren)||$116||$232||$1,647|
|1Same Gender Domestic Partner Tiers (Full-time/Part-time/COBRA)
Medical-Choice EE+SGP: $97 / $194 / $1,236
Medical-Choice EE/Child(ren)+SGP: $116 / $232 / $1,647
Medical-Select EE+SGP: $194 / $388 / $1,333
Medical-Select EE/Child(ren)+SGP: $232 / $464 / $1,774
2This is the full cost of coverage if you or one of your dependents loses coverage under the plan and becomes eligible for COBRA.
The work you do as a St. Jude employee every single day benefits children around the world. To help you look after your own best health, you will no longer pay a co-pay, coinsurance or deductible for in-network preventive services such as:
For details on preventive services, visit www.healthcare.gov. To find an in-network provider of the services mentioned above, visit www.coresource.com. Click the ”Participants" link in one of the boxes on the right side of the page. Click the "GWH-CIGNA PPO" link on the right side of the page.
New in 2013: St. Jude will also pick up the full cost of many women’s preventive services including well-woman visits; gestational diabetes screenings; and contraception and contraceptive counseling and more. For details on preventive services, visit www.healthcare.gov.
|St. Jude will pay 100% of the medical costs for certain in-network preventive services (i.e. health screenings) for you and your family. When you visit a health care provider, the services you receive will be considered either preventive or non-preventive. This determines whether you must pay a co-pay, co-insurance or deductible. In the following scenarios, see if you can determine whether the care received was preventive or not.|
A woman visits her in-network doctor for her annual mammogram.
A woman returns to her in-network doctor for a follow-up diagnostic mammogram because there were questionable results on the first test.
A man who takes medicine for high cholesterol has an annual wellness exam and receives a blood test to measure his cholesterol level.
A man makes quarterly visits to the doctor for blood tests to check his cholesterol level and to confirm his dosage level is appropriate.
Your Medical Plan ID card will also serve as your Prescription Drug Card. This card will show the telephone numbers to call if you have a question about your coverage or need to pre-certify a service or procedure. To protect your privacy, you will receive a unique ID number. However, you may provide your social security number to verify benefits if you prefer.
The best way to search for healthcare providers is online through the Web sites of our benefits vendors because their databases are kept as up-to-date as possible. To search for in-network medical providers, visit www.coresource.com. Click the "Participants" link in one of the boxes on the right side of the page. Click the "GWH-CIGNA PPO" link on the right side of the page.
You probably know from your own experience that the cost of prescription drugs continues to rise dramatically. To help keep your medical expenses as low as possible, the PPO options include a prescription drug program administered by Caremark. When you enroll in either PPO option, you automatically receive prescription drug coverage.Both PPO options include copays for retail and mail-order drugs as shown in the Health Plan Benefits At-A-Glance chart.
The St. Jude Prescription Drug Plan uses Caremark’s three-tiered Preferred Drug list (formulary). Drugs are placed on the formulary based on their clinical effectiveness and safety, as well as cost. Click here to download a pdf of the current list of preferred medications or get the list by logging in to www.caremark.com.
Your share of the prescription drug plan cost depends on the category of the prescription.
Caremark updates the preferred drug list throughout the year as scientific and clinical drug information becomes available.
|Retail-Your local pharmacy
|Caremark Mail Order Program*
|Non-preferred brands/Specialty drugs||$50||$100|
|*Caremark's Fast Start program makes switching to mail order easy!|
Please click here to download the preferred list or visit www.caremark.com or call Caremark at 1-800-213-0879 to determine if a drug is preferred or non-preferred and to estimate costs for specific drugs.
Federal law requires generic and brand drugs to meet the same standards of strength, dosage, safety and effectiveness. Generics typically cost less for both you and St. Jude.
If your doctor prescribes a brand-name drug although a generic is available and you choose to purchase the brand-name prescription, you will pay more for your medicine. Your co-pay will be the total of the generic co-pay, plus the difference between the actual cost of the brand and the generic drug.
Difference in price between brand and generic version of Wellbutrin XL:
Brand-name Wellbutrin costs about $194.31, and the generic equivalent costs $52.99.
|Plus retail generic co-pay||+ $5.00|
|Your cost if you choose to buy the brand-name drug||$146.32|
Talk to your doctor. Ask your health care provider to prescribe generics when available.
Brand Penalty Exception Form. If your doctor has determined that you cannot receive a generic alternative, you can request an exception by having him/her complete this form and faxing it to Caremark’s Appeal Department at 1-866-443-1172. Download the form.
If you are taking maintenance mediations (i.e. drugs taken daily to treat a chronic condition such as arthritis, diabetes, high cholesterol, high blood pressure and heart disease) ask your doctor to write a 90-day prescription for your medication that can be filled through the CVS Caremark mail order program (see info about Fast Start below). You get a three-month supply for the cost of two months.
Note: If you fill a 90-day prescription at your local pharmacy, you will have to visit the pharmacy every 30 days and pay a separate co-pay on each visit.
Call Caremark toll free at 1-800-875-0867 (M-F, 7 a.m. to 7 p.m.) and let them contact your doctor and switch your prescription to mail order. FastStart® makes it especially convenient—and less expensive—for you to get the medications you take on a regular basis, such as those for managing high blood pressure, cholesterol and diabetes. When you call, be sure to have the medication name and your doctor's contact information handy.
Flexible spending accounts help you pay for certain health care and dependent care expenses that are not covered by the medical, dental or vision plans—copays, coinsurance and amounts above benefit maximums to name a few. Likewise, many people have regular daycare expenses for dependent children.
Both the health care and dependent care spending accounts are administered by CoreSource. These flexible spending accounts provide tax advantages by letting you set aside pre-tax dollars to pay certain health care and dependent care expenses.