Medical and Prescription Drug Coverage

WVU Medicine offers four coverage levels with three different medical plan options for the coming year, including a qualified High Deductible Health Plan (HDHP) with Health Savings Account (HSA). The 2018 Medical Plan offerings also feature an enhanced network of providers that reward you with lower costs for using WVU Medicine facilities.

For prescriptions, WVU Medicine utilizes the National Network and uses a closed formulary, meaning that it has a specific list of drugs that are preferred for the WVU Medicine plan. The cost of these drugs are reflected in the Open Enrollment Guide under “Prescription Coverage.” Using a hospital pharmacy will further reduce the cost for prescription drugs.

Employee per pay costs can be found in the Open Enrollment Guide, and will be shown in the UltiPro enrollment tool. If you do not have UltiPro (Reynolds Memorial & St. Joseph’s employees) please visit your hospital intranet site.

Refer to the 2018 Open Enrollment Guide and FAQs for more information, or call the WVU Medicine HR Service Team at 1-833-599-2100 Monday-Friday from 7 a.m. to 4:30 p.m. ET.

2018 Medical Plan Overview

Preventive Services

Preventive Services are covered at 100% under all three medical plan options at network providers. Complete listing of Preventive Services.

Enhanced and Standard Networks

The 2018 Medical Plan options feature an enhanced network of providers that reward you with lower costs for using WVU Medicine facilities. A list of those facilities is available on the WVU Medicine Find a Doctor page.

Laboratories that are in the enhanced network can be found on the WVU Medicine Healthcare Services page.

Each plan also allows for the use of standard network facilities that are in-network, but at a higher cost. For a list of those BCBS standard network providers, visit the Highmark provider listing.  Note: The following list of hospitals will show as being in-network with BCBS, but are out-of-network for the WVU Medicine Medical Plans.

  • Fairmont Regional Medical Center
  • Marietta Memorial Hospital
  • Mon Health Medical Center
  • Preston Memorial Hospital
  • Stonewall Memorial Hospital
  • Winchester Medical Center

Important Coverage Exception: Emergency Care

Enhanced, standard, or out-of-network designations do not apply to emergency care. You can go to any hospital in the WVU Medicine Enhanced, BCBS Standard or out-of-network for emergency services.

Mountaineer HDHP with Health Savings Account (HSA)

The Mountaineer High Deductible Health Plan (HDHP) has a higher deductible and coinsurance limit than most plans, but employees who avoid the Tobacco Surcharge will pay lower bi-weekly premiums. You are responsible for all out-of-pocket expenses until you meet the annual deductible, then coinsurance applies. This plan also provides access to an HSA to which you and the company contribute. When you sign up for the Mountaineer HDHP medical plan, WVU Medicine will contribute money to your HSA. The HSA employer contribution is described in the Open Enrollment Guide.

Health Savings Account (HSA)

An HSA is a tax-advantaged account that allows you to save money on a pre-tax basis for qualified medical, prescription drug, dental and vision expenses. You decide which qualified medical expenses, if any, will be paid using the account. HSAs also allow you to save on your taxes, help offset deductibles and copays, and enable you to save for future medical expenses. The money you put into your HSA is yours, it is not subject to the “Use it or lose it” rules, and therfore unused funds at the end of the plan year carriers over from year to year. It goes with you even if you change employment or retire.

Enrollment in the HSA is automatic through Acclaris, Highmark’s HSA Administrator. No action is required by you to set up your account. You can manage your account online at highmarkbcbswv.com.

Visit IRS.gov  to obtain more detail about HSAs in IRS Publication 969. If you have more specific question we recommend you speak to a tax advisor before you enroll.

Employee Contributions to HSA

In addition to the employer contribution to your HSA, you can make pre-tax contributions to the HSA account. Those amounts are:

Level Annual Limit(Minus Employer Contributions)
Single $2,950
Family $5,900
Age 55 Catch up Contribution $1,000

Flexible Use of HSA Funds

You will be issued a debit card that you can use to pay for your eligible out of pocket healthcare expenses. There is a monthly fee for the HSA that is paid by WVU Medicine as long as you remain an employee. If you terminate employment the monthly fee will be deducted from your HSA balance.

Maximum Out of Pocket Healthcare Costs Examples


Individual Coverage Examples

Family Coverage Examples


2018 Prescription Coverage

Pharmacy Network

WVU Medicine uses the National Network and uses a closed formulary, meaning that it has a specific list of drugs that are preferred for the WVU Medicine plan. Using a hospital pharmacy will further reduce the cost for your prescription drugs. Click here to view the formulary
NOTE: Walgreen is out-of-network.

$0 Copay Healthy Rx Generics

$0 Copay Healthy Rx Generic drugs are low cost alternatives designed to encourage members to purchase and take preventive prescription medications. The list of $0 Copay Healthy Rx Generic drugs includes medications such as anticoagulants, anti-seizure medications, asthma medications, cardiovascular, and cholesterol-lowering medications for the prevention of complications from high blood pressure and high cholesterol, such as heart attack and stroke. Complete listing of $0 Copay Health Rx Generics available through WVU Medicine Pharmacies.

Prescription Coverage and Copays

WVU Medicine Retail Pharmacy
Prescription Drugs: 1 to 30 Day Supply Greater of:
Generic $5 Copay $10 or 50%
Preferred Brand $25 Copay $50 or 50%
Non-Preferred Brand $50 Copay $100 or 50%
Prescription Drugs: 31 to 90 Day Supply
Generic $10 Copay N/A
Preferred Brand $50 Copay  N/A
Non-Preferred Brand $100 Copay  N/A
$0 Copay Healthy Rx Generics $0 Copay N/A
Specialty Drugs – Maximum 30 Day Supply $100 Copay $100 Copay
(Only applicable when not available at WVU Medicine Pharmacies)

Process for Filling Prescriptions

Short-term use medications*

If you want your prescriptions at the lowest cost you will need to have them filled at your hospital pharmacy. A few examples of short-term medications are:

  • Augmentin
  • Z pack
  • Amoxicillin

Maintenance drugs

A maintenance drug is a drug prescribed for chronic, long-term conditions and is taken on a regular, recurring basis. Examples of chronic conditions that may require maintenance medications are high blood pressure, high cholesterol and diabetes. A few examples of maintenance drugs would be:

  • Insulin
  • Lipitor
  • Nasonex

If you cannot get your maintenance prescription at your hospital and want the lower copays you can reach out to the Mountaineer Pharmacy in Morgantown, WV.

Their normal business hours:

  • Monday-Saturday: 8:00 am to 8:00 pm
  • Sunday: 10:00 am to 6:00 pm

Phone number: (304) 285-7348 or 1-833-988-6867
Website: www.mountaineerpharmacy.com
Street address: Mountaineer Pharmacy, 390 Birch Street, Morgantown, WV 26505

Your provider can send a 90-day supply prescription for maintenance drugs electronically to the Mountaineer Pharmacy or call it in at (304) 285-7348 or at 1-833-988-6867(WVU-MTNR) . You have the option to mail the prescription as well but keep in mind that there may be a delay of a few days. The Mountaineer Pharmacy will require a prescription enrollment form.

Mail Order Drugs

If you are interested in mail order for your maintenance prescriptions, you will need to get them through the Mountaineer Pharmacy in Morgantown, WV.

Specialty Drugs

A specialty drug is a drug that must be injected or infused (although some are oral medications). They are used to treat complex or rare chronic conditions such as cancer and rheumatoid arthritis. A few examples of specialty drugs would be:

  • Copaxone
  • Lucentis
  • Taltz

If you cannot get your specialty drug prescription filled at your hospital you can reach out to Allied Health Solutions Specialty Pharmacy in Morgantown, WV 26508. Their normal business hours: Monday-Friday: 8:00 am – 6:00 pm

Phone number: 304-285-7216 or toll-free at 844-988-7216
Fax number: 304-598-4034
Website: www.AlliedHealthSolutionsRx.com

Generally, your doctor will contact Allied Health Solutions and fax or e-prescribe a new prescription. You may also drop off a paper prescription at 3040 University Avenue, Suite 1400, Morgantown, WV 26506.

 

If you are a CCMC employee view the FAQ’s for additional pharmacy information.