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MEDICAL & PRESCRIPTION

MEDICAL & PRESCRIPTION

DG3 North America, Inc. seeks to provide the best possible medical benefits at a reasonable cost. Employees are provided with a medical plan option that includes prescription drug coverage. 

HOW THE PLAN WORKS

Preventive Care: The plan pays 100% for in-network preventive care.

Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is $2,500 for Individual coverage and $5,000 for Family Coverage when you use in-network providers.

Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, co-payments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.

In-Network Advantage (Freedom Network)

When you use an in-network provider, the percentage you pay out-of-pocket will be based on a negotiated fee, which is usually lower than the actual charges. If you use a provider who is outside of the network, you may be responsible for paying for the difference between the Usual, Customary and Reasonable (UCR) charges and what the provider charges. You also may need to submit claim forms

The Freedom Network – enrolled members can get care from over 30,100 physicians  and 67 hospitals in New Jersey plus 60,700 New York and 19,900 Connecticut  providers.

How To Search for a Provider

  1. Log in www.oxfordhealth.com
  2. Click the provider/physician search link
  3. Choose “Freedom”
  4. Enter the 5-digit ZIP code, city or state
  5. Choose from “People,” “Places,”  “Tests and Imaging,” “Services and  Treatments,” or “Care by Condition.”
UHC Oxford HDHP In Network Providers Out of Network Providers
Calendar Year Deductible: Single/Family $2,500 / $5,000 $5,000 / $10,000
Coinsurance 10% after deductible 30% after deductible
Maximum Out of Pocket Limit: Single / Family
(Includes the deductible)
$4,000 / $8,000 $6,000 / $12,000
Office Visit 10% after deductible 30% after deductible
Specialist Office Visit 10% after deductible 30% after deductible
Surgical Services 10% after deductible 30% after deductible
Complex X-Ray and Lab – CT, PET, MRI, MRA 10% after deductible 30% after deductible
Urgent Care Centers 10% after deductible 30% after deductible
Emergency Medical Care 10% after deductible 30% after deductible
In-Patient Hospital Services 10% after deductible 30% after deductible
Out-Patient Hospital Services 10% after deductible 30% after deductible
Prescription Drugs:
Retail (30 day supply)

Tier 1 – $10 / Tier 2 – $25 / Tier 3 – $50 

30% after deductible

Covered at participating pharmacies only

Mail Order (90 day supply) Tier 1 – $20 / Tier 2 – $50 /Tier 3 – $100

30% after deductible

Covered at participating pharmacies only

Your Pharmacy Benefit: OptumRx

Set up your online account

  • Manage your home delivery medications
  • Set-up email or text message reminders
  • Check your order status

Use a network pharmacy

  • Log in to your health plan member website
  • Call the toll-free number on your health plan ID card

Pharmacy Home Delivery

  • Convenience
  • 24/7 access to reminders
  • Order online
  • Order by phone
  • Your doctor can e-prescribe

Understand your pharmacy benefits – know the coverage requirements for your medication

  1. Check your Prescription Drug List (PDL)
  2. Talk to your doctor
  3. Find information on your health plan member website