QUICK LINKS
Eligibility
All regular, full-time employees (those who work a minimum of 37.5 hours per week on a nine-twelve month annual basis) and full-time temporary employees (who have at least a one year appointment) are eligible. Regular part-time employees can enroll in health insurance, but must pay the full premium on a payroll deduction basis.
Enrollment
- Must enroll in health insurance in order to receive prescription drug coverage
- New employees must enroll within their first 30 days of employment
- Annual Enrollment
- A qualifying life event such as birth of a child, marriage, divorce, or involuntary loss of coverage
Benefit
EPO |
PPO |
|
Prescription |
30 day supply | 30 day supply |
| Mail Order | 90 day supply | 90 day supply |
| Your deductible Single Family |
$75 $150 |
$75 |
Your coinsurance |
You pay 10% 30% 40% |
You pay 10% 30% 40% |
Your out of pocket maximum Single |
$1,500 |
$1,500 |
Express Scripts by mail
For some routine maintenance prescription drugs, you can elect to participate in Express Scripts by mail. This program allows you to purchase your prescription drugs in bulk, you may even save money while participating in this program. There is no coverage for prescription drugs dispenses by any other mail-order service other than through Express Scripts family of Pharmacies. To order a prescription drug from Express Scripts follow the instructions below:
- Log onto www.express-scripts.com to obtain a Express Scripts by Mail order form
- Place all new prescription orders or refills together with the completed form and your payment in an envelope
- Checks, money orders, and credit cards are accepted
- Mail completed form, applicable co-payment (s), and prescription orders or refills to:
Express Scripts
P.O. Box 650322
Dallas, TX 75265-0322 - You can also get started by having your doctor fax your prescription to Express Scripts. Provide your doctor with your Member ID (on your insurance card) and ask them to call (888) 327-9791 for instructions. You will be billed later.
Common terms
Brand-name drug is medication that is available only from its original
manufacturer.
Co-insurance is the cost-sharing requirement between you and the plan.
Coverage review is the process of obtaining approval for certain prescription
drugs.
Deductible is the "off the top" amount you are responsible for before the co-
insurance is activated.
Formulary a comprehensive drug list used to highlight preferred products.
Generic drugs contain the same active ingredients and are manufactured to the
same strict federal regulations as its brand-name counterpart. Generic
medications may differ in color, size, or shape.
Step therapy encourages the prescribing of generic drugs to lower the costs of
alternative brand preferred drugs, when appropriate, by using effective
communications to members and physicians.
Useful links and forms
- Express-Scripts Website
- Express-Scripts Drug Formulary and Generic Drug Search
- Express-Scripts by Mail Order
- Prescription Drug Reimbursement Form
- Coordination of Benefit (COB) Claim Form
- Please make sure to write "COB" across the top in bold letters so Medco processes it correctly as a secondary claim. Otherwise they may try to process it as primary.
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The detail of the prescription benefit is contained in the official Plan document. This site is meant to only cover highlights of the prescription benefit. It does not contain all of the details that are included in the Summary Plan Description (SPD) (as described by the Employee Retirement Income Security Act). If there is ever a question about this plan, or if there is a conflict between the information on this site and the formal language of the Plan documents, the formal wording in the Plan documents will govern. Please note that the benefits described on this site may be changed at any time and do not represent a contractual obligation on the part of Marquette University.
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