HealthFlex is a private health plan, not an insurance company. It contracts with BCBS of Illinois to provide the PPO network and to pay claims ONLY; and with Express Scripts to be the pharmacy benefits provider. If you have a question about your benefits or because you cannot satisfactorily settle a claims issue with a vendor, contact Ann Marie Jedlicka, our Willis C.A.R.E. Advocate, at our broker’s office (888) 676-6767. You may also contact the Health Team at the General Board of Pension and Health Benefits (800) 851-2201. Press 1 at the 1st prompt; 0 at the 2nd prompt. Contact the vendors (BCBS, Express Scripts, etc) for claims or pharmacy issues.
Enrollment: Within 30 days of retirement only; if coverage at retirement is waived*, enrollment available within 30 days of loss of other coverage.
*Signed waiver at time of retirement is required.
Type Of Plan: Medicare Companion Plan (must be enrolled in Medicare Parts A+B). Pays only for Medicare eligible expenses. Under 65 Spouses/child dependents of Annuitants over 65 are covered under the Active PPO plan. See Active Participants Medical Plan.
Medicare pays 80% of its allowed amount. The Plan pays 80% of the remaining 20% of the allowed amount. No network required.
Eligibility:
Premiums: Call for 2012 premiums. Barbara Gruezke, Conference Insurance Coordinator (732) 359-1037
Pharmacy:
|
- No deductible - Mandatory mail order for maintenance drugs after 3 retail fills |
Generics Mandatory if available |
Preferred | Non-Preferred |
|---|---|---|---|
| In-Network Retail Pharmacy | $12 | 20% copay Minimum $15 Maximum $45 |
20% copay Minimum $30 Maximum $90 |
| Out-of-Network Retail Pharmacy | Contact Express Scripts/Medco 1 (800) 841-2806 | ||
| Medco (mail-order) up to 90-day supply | $20 | 20% copay Minimum $40 Maximum $120 |
25% copay Minimum $75 Maximum $225 |
Vision: Annual comprehensive vision exam using Vision Service Plan participating physician. Vision Hardware Discount Program is also available through VSP.
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