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An emergency room copay within a hospital will require a $50.00 copay whether you go In-Network, or Out-of-Network under the CIGNA Medical Plan. Please note that this charge will be waived if you are admitted to the hospital within 24 hours of your emergency room visit.

The Trustees understand that a hospital emergency room is the best place to be when you have a true medical emergency (e.g., chest pain, severe or prolonged bleeding, seizures or loss of consciousness, high fever). Dealing with major injuries and illnesses is what an emergency room is designed to do. For non-emergency kinds of conditions, however, an emergency room is not generally the best to receive care. As you might already know, there can be long waits in emergency rooms and they are not typically designed to provide optimal non-emergency care.

Three Tier Copays for Prescription Drugs:

The Health Fund's Pharmacy benefits has three "tiers" of copay levels for prescriptions filled at participating PHARMACY-ENDSTATE pharmacies or through CIGNA’s Tel-Drug Mail-Order Program. This three-tier structure classifies medications as either Generic, Preferred Brand-Name or Non-Preferred Brand-Name drugs. The following chart explains the cost that you will incur when filling a prescription:


Prescription Drug Benefits At A Glance
At ENDSTATE
Pharmacy
At a Non-Participating
Pharmacy
Through the
Tel-Drug Mail-
Order Program
Annual Deductible- Must be satisfied regardless of where you obtain your prescription.
  • Indivudal
$100
  • Family
$200
Maximum Supply
30 days
30 days
90 days
Your Cost
  • Generic
Greater of $10 Copay or
20% of actual cost.
30% of actual cost.
Greater of $20 Copay or
20% of actual cost.
  • Preferred Brand-Name
Greater of $20 Copay or
25% of actual cost.
30% of actual cost.
Greater of $40 Copay or
25% of actual cost.
  • Non-Preferred Brand-Name
Greater of $25 Copay or
30% of actual cost.
30% of actual cost.
Greater of $50 Copay or
30% of actual cost.

As of January 1, 2009, the most any participant will be required to pay in regular prescription drug deductibles and copays combined will be $5,000 annually. Once you hit the cap, the Fund will pay:

  • Generic drugs: 100% of eligible prescription drug expenses for the rest of a calendar year.
  • Preferred Brand-Name drugs: 100% of eligible prescription drug expenses for the rest of a calendar year.
  • Non-Preferred Brand-Name drugs: 95% of eligible prescription drug expenses for the rest of a calendar year. The copay will then be 5% to the
    participant.

The Health Fund will also only require a single copay for a “diabetic kit”, which includes insulin and the supplies required to inject it. (needles and syringes). This will reduce the out-of-pocket costs to a diabetic.

Generic refers to prescription drugs that are the lower-cost equivalents of brand name drugs. And today these drugs can be a better value than ever. Like brand name drugs, generics:

  • are approved by the U.S. Food and Drug Administration (FDA).
  • have the same active ingredients
  • are therapeutically equivalent (that is, they perform the same way in your body).

Where generics differ are in the their names - they're labeled with the medication's basic chemical name - and in the amount of money drug companies
charge for them. Generics generally cost significantly less than their brand name counterparts, resulting in savings for you and the Fund. Depending on
the type of drug, the cost savings generics offer can range from a few dollars to hundreds of dollars per prescription of refill. If you are taking a drug
that's considered a brand-name, you should speak to your doctor to see whether there is a generic equivalent that can work for you. To find out if the
drug you take has a generic equivalent, check the Drug Information Tool at myCIGNA.com or call CIGNA's Health Information at 1-800-CIGNA-24.

The same applies when using Preferred instead of Non-Preferred Brand-Name drugs. You should consult with your doctor to point out the savings
you can enjoy if medications from CIGNA's Preferred Drug List are used each time you fill a prescription. You and your physician can see what
is on the list by using the Drug Information Tool at myCIGNA.com or calling the CIGNA Health Information Line. You can also go to http://cigna.com/health/consumer/pharmacy/drug_lists.html and click on prescription drug list. You will also need to enter our plan type, which is
Tier 3. This list is a compilation of drugs recognized by the FDA as safe and effective and for which CIGNA has arranged manufacturer volume discounts.
It’s complied after an intensive evaluation process and includes only those medications that have been tested for quality and effectiveness. The
Preferred Drug List is regularly evaluated and updated by a committee of medical personnel and pharmacies, so a drug that Non-Preferred today may
be Preferred tomorrow - or vice versa.

For additional information or questions you may have, please feel free to contact the Fund Office or CIGNA.

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