Medical Insurance & Pharmacy Drug Plan

Anthem is dedicated to delivering care to our employees and helping improve the health of our communities. The plan has a strong national network of physicians, hospital and ancillary health care providers.

For more details about this plan, please view Anthem BlueCross BlueShield Summary of Benefits and Coverage.

Pharmacy Drug Plan

When employees enroll in the Medical Plan, they will automatically receive Pharmacy Drug coverage. The network includes more than 69,000 pharmacies across the country. That means you have easy access to your prescriptions wherever you are-at work, home or even on vacation. Using pharmacies in the network will help you get the most from your drug plan. When picking up your prescription at the pharmacy be sure to show your Medical ID card.

Anthem National 4 Tier Drug Formulary
Your Smart 90 Prescription Drug Plan Tier 1
Copay
Tier 2
Copay
Tier 3
Copay
Tier 4 Copay
(Specialty Drugs)

Up to a 30-day medication supply at participating pharmacies

40% coinsurance,
$20 minimum,
50 max/script

40% coinsurance,
$20 minimum,
$100 max/script

40% coinsurance,
$20 minimum,
$100 max/script

40% coinsurance,
$20 minimum,
$100 max/script

Up to a 90-day medication supply delivered to your home

40% coinsurance,
$60 minimum,
$125 max/script

40% coinsurance,
$60 minimum,
$300 max/script

40% coinsurance,
$60 minimum,
$300 max/script

*40% coinsurance,
$60 minimum,
$300 max/script.
90 day mail order benefit only allowed for Transplant & HIV/AIDS drugs.

Up to a 90-day maintenance medication supply purchased at a Smart90 participating** retail pharmacy

40% coinsurance,
$60 minimum,
$125 max/script

40% coinsurance,
$60 minimum,
$300 max/script

40% coinsurance,
$60 minimum, $300 max/script

Not Applicable

*Most specialty medications are limited to up a 30 day supply regardless of whether they are retail or mail. **

If you get the brand name drug when a generic drug is available, you will pay the applicable coinsurance based on the brand drug cost plus the difference in cost between the brand and the generic.

Prescription Drug Out of Pocket Maximum - $4,500 Individual/$9,000 Family (separate from the Medical out of pocket maximum)

Specialty Medication Administered by Accredo CareLogic
Specialty medications are limited to up to 30 day supply regardless of whether they are retail or Mail. For questions contact them at (800) 870-6419.

RX Bin Number – 003858

RX Group Number – WLAA

Rx PCN – A4

Maintenance Medications
Maintenance classified medications must be filled through Express Scripts Mail Order Pharmacy or Smart 90 participating pharmacies after a specified number of 30-day retail fills.

Smart 90 Pharmacies
It is a unique network that offers more ways for you to get the maintenance medications you need. Through Smart 90, you can choose to get a 90-day supply of medications from a participating retail pharmacy. Only certain pharmacies in our network participate in the Smart 90 Program.

Mail Order Administered by Express Scripts
With mail order, you do not have to worry about running out of medication because the pharmacy will let you know when it’s time to order refills. You can easily order by phone (866) 281-4279 (open 24 hours), mail or online (www.express-scripts.com).

Medical & Pharmacy Card

All new enrollees will receive cards from Anthem Blue Cross and Blue Shield.  Dependent or spouse names are not listed on the cards. Activation is not needed, however, we encourage you to access your online services by registering at anthem.com/register; this will allow you access to all of your medical benefits information.  

Who is Eligible to Enroll?

You are eligible for the benefits if you are contracted at least 30 hours per week.

Dependent Eligibility

You can enroll the following members of your family on Medical plan:

  • Your spouse, is defined as the person to whom you are legally married and for whom you have a valid government issued marriage certificate.
  • Your natural children, legally adopted children, children placed with you for legal adoption, stepchildren or foster children up to age 26, regardless of student status.  Coverage ends at the end of the month following the date they turn 26. 
  • Your children age 26 or older who are not able to support themselves because of a physical or mental disability.

Note: When you add a new dependent, you will need to provide proof of his or her eligibility, such as a marriage certificate, birth certificate or adoption certificate.

How Can I Enroll?

New hire must enroll within 31 days of their contract start date by completing the Employee Benefits Enrollment/Change Form. Additionally, employees can enroll within 31 days of a qualifying event or during the annual Open Enrollment Period.

When will my Benefits be Effective?

Coverage will take effect on the first day of the month following your contract start date. Qualifying events is effective the day the event occurred.  All benefits are based on a calendar year (January through December).

Related Materials for Medical & Pharmacy Plans

Note: This information is not intended to be a comprehensive reference and should be reviewed in conjunction with other LCS benefits materials. 

How do I Make Changes?

Changes may be made during Open Enrollment or within 31 days of a qualifying event by completing the Employee Benefits Enrollment/Change FormQualifying event examples include marriage, divorce, birth/adoption/fostering, death of a family member. Click here for more information on adding eligible dependents.

What Happens to my Medical Insurance if I Leave LCS?

Under the provisions of the Consolidated Omnibus Reconciliation Act of 1985, or COBRA, you and your covered family members may choose to continue Medical coverage under the Lynchburg City Schools Medical Plan after your coverage has ended. You have 60 days from the date of your COBRA election notice to enroll in coverage.  The start date is backdated to the date you lost coverage. If you do not respond within the 60 days, your rights to continue coverage will be waived. COBRA information will be mailed to your home address. Please be sure to keep your address current by submitting changes to the Personnel Department.

Questions?

Please contact the Benefits Department at (434) 515-5089, (434) 515-0008, or benefitsdepartment@lcsedu.net.

Plan Administrator Contact Information

Anthem Blue Cross and Blue Shield
PO Box 27401
Richmond, VA 23279
www.anthem.com
(800) 451-1527
8:00 a.m.-6:00 p.m. Monday-Friday; Saturday 9:00 a.m.-1:00 p.m.

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