Pharmacy Plans
The Banner Pharmacy Plans provide benefits for you and your eligible dependents in the event you have covered expenses for prescription drugs. Enrollment is required before coverage can begin.
You and Banner Health share the cost of this coverage. Your monthly cost for any coverage you elect is divided in half and deducted from your paycheck twice a month. Banner Health Pharmacy Plans are self-funded. This means pharmacy claims are paid by contributions you and Banner Health make.
Who is eligible?
You are eligible for pharmacy coverage if you are scheduled to work 32 hours or more per pay period and are classified as a regular full-time or part-time employee.
Eligible dependents include your:
Proof of dependent eligibility may be required during enrollment.
If you would like to cover a domestic partner, you must call the Service Center at Banner Plan Administration at 1-800-827-2464 or in the Phoenix-metropolitain area 480-827-7070.
What are my choices for coverage?
Pharmacy Plan choices available:
- Basic Pharmacy Plan
- Standard Pharmacy Plan
- Expanded Pharmacy Plan
- Select 250 Pharmacy Plan*
* The Select 250 Plan is only available when enrolled in the Select 250 Medical Plan.
When enrolling in a medical plan, you will be required to enroll in a pharmacy plan as well. You may not enroll in one of the pharmacy plans without enrolling in one of the medical plans. You must choose the same level of coverage as your medical level of coverage. That means if you choose a single medical plan, you will only be able to select a single pharmacy plans. If you waive medical coverage you must also waive pharmacy coverage. If you have enrolled in the Banner Select 250 Medical Plan, you will automatically be enrolled in the Select 250 Pharmacy Plan as this is the only option available.
For 2009 Annual Enrollment, the Express Preview web site has been set up to assist you in selecting one of the three pharmacy plans. A fourth informational-only plan has been set up to demonstrate the pharmacy cost you would incur if you had no insurance coverage.
Using this web site, you can compare each plan for an ESTIMATE of specific medication costs and your total annual out-of-pocket costs to decide which plan best meets your needs.
Web site: Express Preview web site
Demo User Name: previewtest Password: password
Detailed information on this benefit such as eligibility, plan coverage, limitations and contact information can be found in the Summary Plan Description (SPD).
Click here to read a copy of the 2008 Banner Pharmacy SPD, 2009 Banner Pharmacy SPD
View the Chart on your left for the most current year to compare choices. Within each of the pharmacy plans you can save additional money in three ways:
- by selecting generic drugs over name brand drugs (save up to 75% or more)
- by ordering long term "maintenance" drugs by mail (save up to 33%)
- by choosing generic or name brand drugs that are part of the formulary (save up to 75% or more)
Choose a Drug on the "Formulary" and Save
"Formulary" is a term used to describe a select list of drugs that Express Scripts and Banner have determined to be safe, high quality and cost-effective choices for a wide variety of therapeutic categories. The formulary includes lower cost generics as well as higher cost name brand medications. Cost becomes the determining factor in a drug's inclusion in the formulary only after all other considerations such as safety and effectiveness are met. The Standard and Expanded Plans are found on the National Preferred Formulary. The Basic and Select 250 Plans are found on the High Performance Formulary. Within both formularies you will save money by choosing generic drugs when available for your particular prescription.
Note: The above formularies are for 2008. The 2009 are:
Mail Order Option for Long-Term "Maintenance" Drugs Offers Convenience, Savings
If you are able to order a 3 month supply of maintenance medications, those you know you will need to take throughout most of the year (for example birth control pills, hormones, blood pressure, etc.), you now have the option of ordering them through the mail. Mail order is not only convenient – the prescriptions are delivered right to your door – your co-payment is also about 33 percent lower than the co-payments would be for buying the same drugs in 31-day supply increments from a local pharmacy.
Express Net Convenience
Use a participating Express Net pharmacy to receive up to a 93-day supply of your medication at a local retail pharmacy. You won't be eligible for the mail order discount on the co-pays, but you will gain the convenience of picking up a three-month supply instead of visiting your pharmacy once a month for a refill.
How do I enroll?
You make your dental plan coverage election during your initial eligibility period or during the Annual Enrollment period. You will receive a price sheet showing the dental plan options available to you including your cost of coverage.
You can find step-by-step information on how to enroll by clicking on the "Enroll for Benefits" button located in the top right-hand side of this and any page on this website.
Your coverage begins the first of the month following enrollment unless your hire date is on the first of the month. In this case, your effective date is the same as your hire date. Enrollment must be completed no later than the 30 days after employment or in a newly eligible employment classification. If you wish to enroll at a later date, you may enroll only during the Annual Enrollment period for an effective date of January 1st. If you have a qualifying event, you may be eligible to enroll at other times during the plan year.
What is my cost for coverage?
You and Banner Health share the cost of coverage for pharmacy plan benefits. Your cost for coverage depends on the type of pharmacy plan you select and the eligible dependents you choose to cover. The price sheet in your enrollment materials shows your cost for coverage and the amount of the contribution you receive from Banner Health.
Your premiums are collected over the calendar year through 24 regular deductions from your paycheck. Benefit deductions are taken on a pre-tax basis unless coverage is elected for a domestic partner. The costs for coverage are subject to change from year to year.
Where can I find more information?
Information is provided during the Annual Enrollment process, throughout the year at new employee orientation, and through your facility Benefit Plan Representative. For a list of participating pharmacies and additional information, visit Express Scripts.
After the enrollment and confirmation process is completed, the pharmacy plan you selected will be coded on your medical ID card. In addition, you may access a Summary Plan Description (SPD) online by clicking on the links above or at your human resource office that outlines the eligibility, COBRA and ERISA rights governing your pharmacy Plan. This booklet contains details on your pharmacy option coverage including how the benefits work, what expenses are covered, and what expenses are limited or excluded. You may also receive information during the year regarding updates to the formulary, claims and explanations of benefits, and other important news on pharmacy plan benefits and services from Benefits Administration and/or the carrier.
Continuing Coverage
In the event you leave Banner Health, coverage for you and your qualified covered dependents may be extended through COBRA. For COBRA information, call the COBRA Provider Customer Service Number at 1-800-224-1346. The customer service number is available:
- 7:00 am - 6:00 pm Central Time
- 6:00 am - 5:00 pm Mountain Standard Time
- 5:00 am - 4:00 pm Pacific Time
Important to note
This page contains highlights of your pharmacy plan choices and benefit comparisons. The details of how the pharmacy plan choices work are included in the legal documents and contracts that govern how the plan operates. In the event of a difference between this page and the legal documents and contracts, the legal documents and contracts will rule. This insert does not imply a contract of employment or guarantee of benefits. Banner Health reserves the right to change or discontinue all or part of the pharmacy plan benefits at any time for any reason.
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