Transcription of Essentials Formulary E1/E4 Effective 12-01-2021
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Essentials Formulary E1/E4 Effective 12-01-2021
Essentials Formulary E1/E4 Effective 12-01-2021 LIST OF COVERED DRUGS How to use this list: On a high-deductible, health savings account (HSA)? Refer to the E1 Formulary . For all covered drugs, once you have satisfied your medical deductible, you will pay your applicable coinsurance until you reach your out-of-pocket maximum for the plan year. The drug tiers do not apply. On a PPO plan? Refer to the E4 Formulary . Your drugs fall into 4 tiers: Preferred Generic (1), Preferred Brand (2), Preferred Specialty (3) and Non-Preferred Drugs (4) Please see the chart on page v for information. Have questions? Please call customer service at 800-722-1471 (TTY:711), Monday through Friday, 5 to 8 Pacific (11-30-2021 ii Essentials ( E1/E4 ) List of Covered Drugs ( Formulary ) What is the list of covered drugs ( Formulary )?)
Essentials Formulary E1/E4 Effective 12-01-2021 . LIST OF COVERED DRUGS. How to use this list: On a high-deductible, health savings account (HSA)? Refer to the E1 formulary. For all covered drugs, once you have satisfied your medical deductible, you will pay your applicable coinsurance until you reach your out-of-pocket maximum for the plan year.
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