Medical and Prescription Drug Plans

When you feel your best, you are at your best—for you, and the people you care about, too. We provide zero to low health premium costs so you can take care of what matters and feel good while doing it.  

BlueCross BlueShield of Tennessee (St. Jude medical plan administrator)

St. Jude partners with home of the blues—BlueCross BlueShield of Tennessee!

Our partnership brings:

• Broader network
  • Call (888) 796-0609 or search the BlueCross site to find in-network providers. 
    • Search “Blue Network P” for providers in Tennessee.
    • Search “BlueCard PPO” for providers outside of Tennessee.
• Access to international network that includes more than 200 countries.
• Medical plan advocate available virtually to help employees navigate plans and the claims process.
• Teladoc Health— telehealth benefit; 24/7 access to an MD; $15 copay. Doctors can diagnose symptoms and write prescriptions. Use Teladoc Health for:
  • Allergies
  • Cold and flu
  • Fever
  • Sinus infections
  • Respiratory issues
  • Skin conditions (rashes or insect bites)
  • Sore throat
  • Urinary tract infections
  • Common pediatric conditions include: cold and flu; constipation; ear aches; diarrhea; nausea and vomiting; and pinkeye.

• Healthy Maternity: Benefits for an expecting mother through every stage of her pregnancy including personalized, one-on-one support from a maternity nurse and additional tools to support her every step of the way. Participants who enroll within 28 weeks of pregnancy are eligible for a free electric breast pump.
• Fertility Coverage and Menopause Support: included under medical enrollment and provided through Progyny
• The group plan number is 130449.
• BlueCross customer service hotline: 888-796-0609

Select PPO and Choice PPO

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. BlueCross 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.

• Select PPO—potentially lower out-of-pocket expenses; higher monthly premiums
  When you choose care through the Select PPO, you pay higher monthly premiums but potentially less out-of-pocket expenses when you use the plan for treatment and services throughout the year. This plan might appeal to you if paying higher premiums for the peace of mind of having less out-of-pocket costs than the Choice PPO is important to you.
• Choice PPO—potentially higher out-of-pocket expenses; lower monthly premiums
  When you select care through the Choice PPO, you pay lower monthly premiums, but potentially more out-of-pocket when you use the plan for treatment and services throughout the year. This plan might appeal to you if lower monthly contributions are important.

Health Plan Benefits-At-A-Glance (pdf)

Summary of Benefits and Coverage: Choice Plan (pdf)

Summary of Benefits and Coverage: Select Plan (pdf)

Coverage Levels (Tiers)

For medical coverage, you can choose from four levels (tiers) of coverage or waive coverage:

Bi-Weekly Premiums

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.

Tobacco User Premium Surcharge

In recognition of the health risks of smoking and tobacco use, St. Jude is a smoke-free campus for employees. In a continuing commitment to promote good health, St. Jude has implemented a premium surcharge ($50/month) for employees who use tobacco products and enroll in the St. Jude medical plan. All employees must complete the Tobacco User Affidavit upon hire. Employees can avoid the surcharge by completing an 8-week tobacco cessation program, which is provided at no cost to employees. The program is administered by the St. Jude employee wellness program, Living Well. (Living Well will work with employees who cannot complete the 8-week session and need an alternative program.)

Cost of certain in-network preventive care (i.e., annual checkups, routine vaccinations) are fully paid by St. Jude

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 no longer pay a co-pay, coinsurance or deductible for in-network preventive services such as:

• Blood pressure, diabetes and cholesterol tests
• Many cancer screenings (mammograms, colonoscopy, etc.)
• Certain services from your health care provider such as smoking, weight loss, depression and alcohol use
• Routine vaccines for diseases such as measles, polio or meningitis
• Flu and pneumonia vaccinations
• Counseling, screening and vaccines for healthy pregnancies
• Regular well-baby and well-child visits, from birth to age 21

For details on preventive services, visit www.healthcare.gov. Call (888) 796-0609 or search the BlueCross site to find in-network providers. Search “Blue Network P” for providers in Tennessee. Search “BlueCard PPO” for providers outside of Tennessee. 

Medical Plan and Prescription Drug ID Cards

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.

How do I find out if my healthcare provider is in our network?

The best way to search for healthcare providers is online through the websites of our benefits vendors because their databases are kept as up-to-date as possible. Call (888) 796-0609 or search the BlueCross site to find in-network providers. Search “Blue Network P” for providers in Tennessee. Search “BlueCard PPO” for providers outside of Tennessee. 

Prescription Drug Coverage

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. Rx plan uses a Preferred Drug list (formulary).

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. Log in to www.caremark.com to download a pdf of the current list of preferred medications.

Your share of the prescription drug plan cost depends on the category of the prescription.

• Generic and preferred-brand drugs have the lowest co-pays.
• Non-preferred brand-name drugs carry the highest co-pay. If your physician prescribes a non-preferred drug, you may consider contacting your physician or refer to the Web site www.caremark.com for alternative therapeutic drugs in the “generic” and/or “preferred drug” categories, as this will lower your co-pay.

Preferred Drug List

Caremark updates the preferred drug list throughout the year as scientific and clinical drug information becomes available.

Visit www.caremark.com or call Caremark at 1-866-240-4916 to determine if a drug is preferred or non-preferred and to estimate costs for specific drugs.

Priority for generics

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.

Talk to your doctor.  Ask your health care provider to prescribe generics when available.

Generic Step Therapy

Do medicines that cost more always work better? Nope. In fact, many lower-cost medicines provide great health benefits while saving you money. 

For certain conditions such as ulcers, acid reflux disease, and some types of pain or inflammation, employees and family members enrolled in the plan must try one or more generic alternatives before a brand named drug will be covered. When you submit a prescription for a medication that is not a "first-step" drug, it may be rejected. So ask your doctor about lower-cost alternatives before filing a prescription.

90-day supplies at retail CVS stores and the Living Well Pharmacy; 31-day supply limit at other local pharmacies (retail)

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.

St. Jude employees can now fill 90-day prescription supplies at any retail CVS/pharmacy or the Living Well Pharmacy for the same price as mail order. By going to the pharmacy, you will get your prescriptions the same day and be able to talk face-to-face with a pharmacist. You must use a CVS/pharmacy location or the Living Well Pharmacy; not applicable to other network pharmacies.

Prior Authorizations and Quantity Limits

To promote proper use of medications while deterring overuse, St. Jude uses prior authorizations and quantity limits for select medications.

Prior authorization, which requires prescribers to confirm medical necessity, will be required for ADHD (Attention Deficit Hyperactivity Disorder) medications for those over age 19 and narcolepsy (sleep disorder) class drugs. Be sure your doctor obtains prior approval by calling 1-800-213-0879 before you try filling a prescription for these medications.

Quantity limits establish a maximum amount allowed over a period of time for medications that have a potential for overuse and misuse. If your doctor feels it’s medically necessary to exceed the limit, he or she must get prior approval by calling 1-800-213-0879 before the higher quantity can be covered.

Switching to Mail Order is a snap with Caremark’s FastStart®!

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 Account (FSA)

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 Health Equity. These flexible spending accounts provide tax advantages by letting you set aside pre-tax dollars to pay certain health care and dependent care expenses.

Learn more about FSAs.