C and O Employees' Hospital Association

 

 

2017

Summary of Benefits and Coverage for plans below:

SBC Plan One Revised 2017 Nov 21 2017.doc

SBC Plan Two 2017.doc

SBC Plan Three 2017.doc

SBC Plan Four 2017.doc

SBC Plan Five 2017.doc

SBC Plan Eleven 2017.doc

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ACTIVE AND RETIRED, NON-MEDICARE COVERED MEMBERSHIP

NOTICE OF CHANGES IN MEDICAL AND PRESCRIPTION DRUG BENEFITS

CHANGES TO YOUR MEDICAL BENEFITS EFFECTIVE JANUARY 1, 2017:

We have made some changes to your medical benefits. Please find enclosed a "Summary of Benefits and Coverage" and a more extensive document, Rules and Regulations and Master Plan Document for a description of the benefit changes.

We have also enclosed your new membership identification card. You should begin using your new card effective January 1, 2017. Make sure you show this new card to your providers as it has been updated to reflect some of the new coverage changes.

CHANGES TO YOUR PRESCRIPTION DRUG BENEFITS THROUGH NAVITUS EFFECTIVE JANUARY 1, 2017:

We have made the following changes to your prescription drug plan:

Tier 2 (formulary brand and some higher cost generics) copayment was increased from $38 to $50 for 90-days when filled at your local participating pharmacy. If you utilize the mail order service, the copayment for 90 days will be $35.
Tier 3 (non-preferred brand drugs), which could include both brand and generic products, copayment was increased from $70 to $90 for 90-days when filled at your local participating pharmacy. If you utilize the mail order service, the copayment for 90 days will be $65.
We will no longer cover prescription or over-the-counter PPI ulcer (gastric reflux) drugs.

If you have any questions, please do not hesitate to contact us toll free at 1-800-679-9135 or locally at 862-5728.

 

RETIRED MEMBERSHIP, PLAN FOUR

NOTICE OF CHANGES IN MEDICAL AND PRESCRIPTION DRUG BENEFITS

 

CHANGES TO YOUR MEDICAL BENEFITS EFFECTIVE JANUARY 1, 2017:

 

We have made some changes to your medical benefits. Please find enclosed a "Summary of Benefits and Coverage" and a more extensive document, Rules and Regulations and Master Plan Document for a description of the benefit changes.

We have also enclosed your new membership identification card. You should begin using your new card effective January 1, 2017. Make sure you show this new card to your providers as it has been updated to reflect some of the new coverage changes.

If you have any questions, please do not hesitate to contact us toll free at 1-800-679-9135 or locally at 862-5728.