Your medical plan automatically includes prescription drug coverage, giving you access to thousands of pharmacies and affordable options for the medications you need. Coverage works a little differently depending on which plan you’re in, so review the detailed plan comparisons.
The prescription benefits are designed to:
Select your plan below to learn more.
Access participating retail pharmacies, refill or request mail-service prescriptions, track order status, view prescription history, and more via the CerpassRx microsite at cerpassrx.com/ensign. All specialty medications must be obtained through a CerpassRx specialty pharmacy.
If you’re enrolled in one of the Personify Health plans, your prescription coverage is provided through CerpassRx, giving you access to a wide network of national chains and local pharmacies. Generic prescriptions start at low copays, with brand-name and specialty drugs available at set copays or coinsurance. For added convenience and savings, you can use the mail-order program to get a 90-day supply of long-term medications delivered right to your door.
| Plan Features | Personify Health Medical Plans | ||
|---|---|---|---|
| Value Copay Plan | Choice HSA Plan | Premier EPO Plan | |
| In-Network Only | In-Network1 | In-Network Only | |
| You pay: | You pay: | You pay: | |
| Calendar Year Deductible2 Individual/Family In-Network Individual/Family Out-of-Network |
$5,000 / $10,000 Not covered |
$2,0003 / $4,0003 $4,0003 / $8,0003 |
$1,000 / $2,000 Not covered |
| Calendar Year Out-of-Pocket Maximum Individual/Family In-Network Individual/Family Out-of-Network |
$7,000 / $14,000 Not covered |
$6,0003 / $12,0003 $12,0003 / $24,0003 |
$2,000 / $4,000 Not covered |
| Prescription Drugs: Retail (up to a 30-day supply)5 | |||
| Specified Preventive Drugs6 | FREE or $10 copay7 | FREE or $10 copay7 | FREE or $10 copay7 |
| Generic | $10 copay | $10 copay4 | $10 copay |
| Brand Formulary | $25 copay 4 | $25 copay4 | $25 copay |
| Brand Non-Formulary | $40 copay 4 | $40 copay4 | $40 copay |
| Specialty8 | 20%4 up to $125 | 20%4 up to $125 | 20% up to $125 |
| Prescription Drugs: Mail Order (up to a 90-day supply) | |||
| Specified Preventive Drugs6 | FREE or $20 copay7 | FREE or $20 copay7 | FREE or $20 copay7 |
| Generic | $20 copay | $20 copay4 | $20 copay |
| Brand Formulary | $50 copay4 | $50 copay4 | $50 copay |
| Brand Non-Formulary | $80 copay4 | $80 copay4 | $80 copay |
1Out-of-network coverage is available.
2Non-embedded deductible, therefore, the family deductible must be met before an individual receives benefits.
3In- and out-of-network deductibles and out-of-pocket maximums are separate and do not cross-accumulate.
4After deductible.
5A $10 copay will be added to the cost for any prescriptions filled at Walgreens.
6As specified in the essential drug list.
7Applies to certain brand-name preventive drugs not covered under the Affordable Care Act.
8May be available at CerpassRx retail pharmacy or Pharmacy Mail Service if authorized. Note that any specialty drug discount coupons will not apply towards the calendar year deductible or out-of-pocket maximum.
If you’re enrolled in one of our regional health plans (Centivo, Kaiser, or SIMNSA) you’ll receive prescription coverage that’s designed to be convenient and cost-effective. Each plan partners with its own pharmacy network, so where and how you fill prescriptions depends on the plan you choose.
| Plan Features | Centivo (Southern CA, Denver, Dallas, Houston, Kansas City, Seattle, Spokane, and Phoenix) |
Kaiser Permanente (California, Colorado, Oregon, and Washington) |
SIMNSA (San Diego County) |
|---|---|---|---|
| PCP | HMO with HSA | HMO | |
| In-Network Only | In-Network Only | In-Network Only | |
| You pay: | You pay: | You pay: | |
| Calendar Year Deductible Individual/Family |
$1,000 / $2,000 | $3,000 / $3,400 (individual within a family) / $6,0001 | Not covered |
| Calendar Year Out-of-Pocket Maximum Individual/Family |
$4,000 / $8,000 | $4,425 / $8,850 | $6,350 / $12,700 |
| Prescription Drugs: Retail | Up to a 30-day supply3 | Up to a 30-day supply | Up to a 30-day supply |
| Specified Preventive Drugs | FREE or $10 copay4 | FREE | FREE |
| Generic | $10 copay | $10 copay2 | $10 copay |
| Brand Formulary | $25 copay2 | $30 copay2 | $10 copay |
| Brand Non-Formulary | $40 copay2 | $30 copay2 | $10 copay |
| Specialty | 20%2 up to $1255 | 20%2 up to $125 | $10 copay |
| Prescription Drugs: Mail Order | Up to a 90-day supply | Up to a 100-day supply | Up to a 90-day supply |
| Specified Preventive Drugs | FREE or $20 copay4 | FREE | Not covered |
| Generic | $20 copay | $20 copay2 | Not covered |
| Brand Formulary | $50 copay2 | $60 copay2 | Not covered |
| Brand Non-Formulary | $80 copay2 | Not covered | Not covered |
1Non-embedded deductible, therefore, the family deductible must be met before an individual receives benefits.
2After deductible.
3A $10 copay will be added to the cost for any prescriptions filled at Walgreens.
4Prescription may bypass deductible or be FREE if it is included on the Preventive Drug or Affordable Care Act list or if the medication is a low cost generic.
5May be available at CerpassRx retail pharmacy or Pharmacy Mail Service if authorized. Note that any specialty drug discount coupons will not apply towards the calendar year deductible or out-of-pocket maximum.
CerpassRx
cerpassrx.com/ensign
844-622-4369
SIMNSA
simnsa.com
