Medical Coverage


THE POS PLAN

The POS Plan is a conventional medical plan where members pay co-pays for some services (co-pays are fixed fee amounts that you pay at the time you receive services).

The POS Plan also uses co-insurance for some services (co-insurance is the portion of expense you must pay for care, in most cases, after meeting your deductible). The deductible is a set amount that typically you must pay before co-insurance starts. For more information (and deductible amounts), view the 2018 Medical Plan Quick Guide.

The POS Plan allows members to receive services from a national network of providers and facilities. It is an open access plan that:

EHN and In-Network preventive care is covered at 100% and is not subject to the deductible. For all other medical services, the plan pays a portion of your covered expenses: 85% for Emory Healthcare Network (EHN), 75% In-Network (Aetna National) and 50% percent Out-of-Network after you pay the annual deductible. Office visits are covered with a co-payment. Prescription drugs are covered through co-insurance.

The POS Plan also has an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year. The out-of-pocket maximum includes all co-pays, as well as deductibles and co-insurances, such as prescription drug costs and office visit co-pays.


arrow  MEDICAL PLAN RATES

medical rates



arrow  POS PLAN PRESCRIPTION DRUGS

Prescription drug coverage is part of your medical plan and you pay a percentage of the cost though co-insurance. There is also a retail or mail minimum and maximum within a five-tier structure (see chart below). You will pay the co-insurance amount subject to the minimum and maximum cost. You do not have to meet your deductible first.

Emory’s prescription drug administrator, CVS/caremark provides you with convenient access to CVS retail pharmacies throughout metro Atlanta. To determine your coverage tier or cost, contact CVS/caremark at 866-601-6935.

Maintenance Drugs: If you take any maintenance prescription medications to treat certain ongoing medical conditions, you will need to fill your 90-day prescriptions in one of three ways: through CVS/caremark’s mail order service, at a CVS retail pharmacy location (at the mail-service cost), or at an Emory pharmacy. If you attempt to fill a maintenance drug at a pharmacy other than CVS or Emory, you will be charged the full retail cost.

Tier Zero: Emory pays 100% and plan participants will pay $0 for a 90-day supply of those medications associated with the prevention and treatment of congestive heart failure (CHF), diabetes, high blood pressure, high cholesterol, smoking cessation and contraceptives. Tier Zero helps members afford the prescription drugs they need to improve or maintain their health. Click here for a list of Tier Zero drugs.

 prescription drug chart

arrow  Save Money on Your Prescriptions

One great way to save on costs is to buy generic drugs. Always ask your doctor and/ or pharmacist if a generic version is available.