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  • Medical and Pharmacy

    Benefit:

    Medical and Pharmacy

    Description: There are two High Deductible Health Plan (HDHP) options, one with a Health Savings Account (HSA) and one without. The medical benefits are administered by Aetna and the pharmacy benefits are administered by CVS/caremark.

    Members will continue to have full access to all in-network pharmacies for their prescription needs.  Your plan is based on a combined deductible of medical and prescription claims. The deductible is the total out-of-pocket spending required by you before benefits are paid. Your annual deductible is $2,000 for an individual or $4,000 for a family. Until this deductible is met, you will pay 100 percent for your medical and pharmacy.        


    Pima County Medical - Administered by AetnaAetna

    • Aetna Choice POS II (Open Access) Network
    • Preventive care covered at 100 percent
    • No referral necessary (prior authorization required for some services)
    • May choose non-participating providers with higher deductible and co-insurance

    Pima County Pharmacy - Administered by CVS/caremarkCVS/caremark

    • Members will have access to all in-network pharmacies (not limited to CVS pharmacies)
    • Mail-order available
    • Specialty medications will be dispensed at CVS pharmacies only
    • Use your medical/RX card for both your medical and prescription needs.
    Eligibility: Refer to Pima County Personnel Policy 8-122 for more information.
    Rates: Medical, Dental & Vision Rates 2019/20
    Additional Resources: Summary Plan Description (SPD) 2019/20
    Schedule of Benefits (SOB) 2019/20 S
    Summary of Benefits and Coverage (SBC) 2019/20
    CVS Preventative Drug List
    CVS Caremark Benefits Overview
    Medical Claim Form            
    CVS/caremark Reimbursement Claim Form           
               

    CVS/Employers Health Toll Free Number (TFN): 888-202-1654

    CVS Specialty Pharmacy
    TFN: 800-237-2767

    When you call in, press “2” for “New Member”. Once you’ve established your account and have a question, you will press “1” for “Existing Member”. Please indicate you are a Pima County employee.

    Webpage: www.caremark.com

    Welcome to CVS/caremark™

    CVS is the current pharmacy provider. Members will continue to have full access to all in-network pharmacies for their prescription needs.

    Your prescription benefits are managed the same way your health insurance company manages your medical benefits. That means helping you get the medication you need, when you need it, whether that’s once a month or once a year. And along the way, we’ll help you find ways to save. Welcome to a prescription plan that has your best health at heart.

    Your plan is based on a combined deductible of medical and prescription claims. The deductible is the total out-of-pocket spending required by you before prescription benefits are paid. Your annual deductible is $2,000 for an individual or $4,000 for a family. Until this deductible is met, you will pay 100 percent for your prescriptions.

    CVS

    Contact Aetna Concierge at 1-800-784-3989 for questions regarding coverage, finding a doctor, looking up a claim or learning more about your wellness benefits.

    You may also speak to a Customer Care Representative through Aetna Navigator at www.aetna.com

    Find doctors, dentists, pharmacies and hospitals

    • Made sure your doctor is in our network before you go
    • Look for a new doctor near your home or work

    Get an ID card

    • Print a temporary card or order a new card

    Look up a claim

    • Check to see what your doctor billed, how much your health benefits and insurance plan paid, and what do you have to pay
    • Find out how claims work

    Check your coverage

    • Check who is on your plan and check what your plan covers

    Keep track of health care costs

    • Check what a procedure may cost in your area
    • See how much you've paid so far and how much you have left to pay of your deductible
    • Check the price of a drug before you go to the pharmacy

    Look what else you can doDocfind

    • Prescription drugs via mail order program available
    • Get a summary of your doctor visits, medical tests, prescriptions and other health activities
    • Create/Print your Personal Health Record
    • Complete a Health Assessment
    • Get health living tips
    • Sign up for a wellness program

    Health info on the go

    Use your smartphone to find a doctor, view your ID card, check the status of a claim and more.

    It's easy to get started

    If you're a new member, go to www.aetna.com and select "Register now". Already signed up? Log in now to take advantage of the features and tools.

    In order to use this service, members must be registered.  To register, visit www.teladoc.com/Aetna or call (855) TELADOC (855) 835-2362.

    Teladoc give you access 24 hours, 7 days a week to a U.S. board-certified doctor through the convenience of phone, video or mobile app visits. Once you’ve requested a consult, a doctor will call you back typically within 10 minutes.

    It’s an affordable option ($40 per visit) for quality medical care. It is less expensive compared to an urgent care or emergency room visit.

    GET THE CARE YOU NEED

    Teladoc doctors can treat many medical conditions, including:

    • Cold & flu symptoms
    • Allergies
    • Pink eye
    • Ear infection
    • Respiratory infection
    • Sinus problems
    • Urinary Tract Infection
    • And more!

    WHEN CAN I USE TELADOC?

    Teladoc does not replace your Primary Care Physician (PCP), but it is a convenient and affordable option for quality care.

    • When you need care now
    • If you're considering the ER or Urgent Care for a non-emergency issue
    • On vacation, on a business trip or away from home
    • For short-term prescription refills
    Taking an active role in your health is the best way to prevent disease, get great care, and reduce costs at the same time. A smart healthcare consumer doesn’t just ask the right questions of their doctor, but knows it’s also about prevention, self-care, and knowing where to find resources. By being a smart healthcare consumer you can make good decisions that will have a positive impact on your physical and financial health. Here are some tips:

    Choosing a Primary Care Physician (PCP) - Putting in as much time to select a new vehicle or appliance as you do your PCP will benefit you greatly.

    Maintain a Healthy Lifestyle - Healthy living is one area of your life you can control. By exercising regularly, eating a healthy diet, being tobacco free, and getting adequate rest, you may help to ward off preventable chronic conditions such as diabetes, cancer, and cardiovascular disease.

    Practice Prevention - By getting the age-appropriate health screenings and immunizations, you are taking a proactive approach to prevent potential conditions. In addition, by knowing what you can do at home to help minimize the symptoms of a cold or flu, you can prevent unnecessary trips to the doctor’s office.

    Look for Ways to Save Money - There are many ways to save money when it comes to seeking care, such as using in-network doctors and facilities. Look for ways to save on your prescription drugs by asking for a generic equivalent or using the mail order option. You should also check your medical bills and explanation of benefits for accuracy, and seek the most appropriate and cost-effective places for your condition.

    Finally, you can earn up to 100 Healthy Lifestyle Activity Points(HLAPs) by signing up and completing the Self-Care Essentials Program.

    Additional Resources:
  • Being Smart About Medical Tests
  • Prepare for Surgery
  • You Deserve Quality Health Care
  • Your Doctor is Your Partner in Health Care
  • 5 Steps to Safer Health Care
  • Interacting with Your Health Care Team
  • Talking with Your Doctor
  • Finding a Good Doctor
  • Preventive health exams or screening services are covered at 100%. They include: Important Note: These services do not include diagnostic exams for current chronic health conditions. Please request a routine preventive exam with your doctor when scheduling your appointment.
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    150 W. Congress St., 4th Floor
    Tucson, AZ 85701

    Phone: (520) 724-8464
    Fax: (520) 724-8150


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