Prescription Drug Plan

Eligibility to Enroll in the State Health Benefits Program

• Regularly appointed full-time employees (100%) with an appointment of 12 months or greater for calendar year employees or 10-months for Academic Year employees
• Legal spouse
• Same-sex domestic partner or civil union partner
• Eligible children under age 26 (including stepchildren, foster children, adopted children or children an employee is legally required to support)

When Coverage Begins

• Academic year 10-month employees with September 1 hire date = September 1 effective date
• All other employees, effective after 2 months of continuous employment, i.e., August 15 hire date = October 15 effective date

Program Overview

• Administered by Medco Health Solutions
• Over 60,000 pharmacies nationwide participate
• Most pharmacies in New Jersey participate
• Prescription copayments determined by the health plan selected

NJ Direct 15, Aetna HMO, Cigna HMO

Retail Prescription Copayments

• $3.00 Generic Copayment
• $10.00 Brand Name Copayment (No generic available)
• $25.00 Brand Name Copayment

Mail Order Prescription Copayments

• $5.00 Generic Copayment
• $15.00 Brand Name Copayment (No generic available)
• $40.00 Brand Name Copayment

NJ Direct 1525, Aetna 1525, Cigna 1525

Retail Prescription Copayments

• $7.00 Generic Copayment
• $16.00 Brand Name Copayment (No generic available)
• $35.00 Brand Name Copayment

Mail Order Prescription Copayments

• $18.00 Generic Copayment
• $40.00 Brand Name Copayment (No generic available)
• $88.00 Brand Name Copayment

NJ Direct 2030, Aetna 2030, Cigna 2030

Retail Prescription Copayments

• $3.00 Generic Copayment
• $18.00 Brand Name Copayment (No generic available)
• $46.00 Brand Name Copayment

Mail Order Prescription Copayments

• $5.00 Generic Copayment
• $36.00 Brand Name Copayment (No generic available)
• $92.00 Brand Name Copayment

NJ Direct HD 4000, Aetna HD 4000, Cigna 4000

• Prescription is integrated with the medical plan and subject to deductible and coinsurance

NJ Direct HD 1500, Aetna HD 1500, Cigna 1500

• Prescription is integrated with the medical plan and subject to deductible and coinsurance

Helpful Documents

• Third Tier Copayment Exception
• Preferred Prescriptions Member Guide

 

Resources To Help You
Benefits Specialist	848-932-3990
Medco Health Solutions	866-220-6512
Employee Pre-Tax Medical and Prescription Insurance Premium Estimator
2012 Medical and Prescription Drug Rates
Health Benefits Contribution Chart for Single Coverage
Health Benefits Contribution Chart for Member & Spouse/Partner or Parent & Child(ren)
Health Contributions Chart for Family Coverage
Prescription Drug Plan FAQs
Prescription Drug Plan Member Handbook

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Last Updated: 02/23/2012