Prescriptions are filled at your participant pharmacy through Sav-RX. Your prescription benefit is managed by Sav-RX. Under this plan, The Self Funded Medical Plan pays for a large part of the cost of medically necessary drugs and medicines. You and your dependents can buy the prescriptions you need to preserve your health.
If there is any problem filling the prescription, you or the pharmacist can call our office at 408/288-4456 or 408/288-4457 during business hours for immediate help. Over 90% of all pharmacies are Sav-RX members. To find out if a certain pharmacy accepts your card, call the pharmacy directly or log on to www.savrx.com to find a nearby pharmacy.
CRX International is a discount prescription drug plan and is in addition to your Sav-RX prescription plan. For more information call CRX toll free at 1-866-488-7874, Monday- Friday 5:30am- 3:30pm Pacific Time or Saturday 6am- 2:30pm Pacific Time.
Sav-RX Mail Service Pharmacy
Members may save time and money by obtaining their prescription medication through the Mail Service Pharmacy. The Mail Service Pharmacy is designed mainly for maintenance type medication for treatment of chronic or long-term conditions such as diabetes, arthritis, heart conditions, and high blood pressure, but may be used for any prescription medication, including oral contraceptives.
OUT OF POCKET
|$300 per person per calendar year, limited to $600 per family, per calendar year.
$3,000 per person per calendar year, limited to $6,000 per family per calendar year.
(Inpatient or Outpatient)
|PPO – 90% of the contract rate. $1,000 in-patient only hospital admission charge.
Non PPO – 70% of usual and customary charges.
|PPO||90% of the negotiated rate for the first $30,000 per person of covered charges per calendar year; 100% thereafter.
After $30,000 of PPO covered expenses in excess of the Deductible, in a calendar year, reimbursement is made at 100% of the contract rate during the remainder of the calendar year.
|Non‑PPO||70% of UCR for the first $50,000 per person of covered charges per calendar year; 100% thereafter.
After $50,000 of Non-Preferred Provider covered expenses in excess of the Deductible in a calendar year, reimbursement is made at 100% of the Usual and Customary Charges during the remainder of the calendar year.
|Physician||Office Visit – $30.00 co-pay for a preferred provider physician instead of a deductible. Does not apply towards deductible. This $30.00 co-pay does not apply to Retirees on Medicare
Non PPO – 70% of usual and customary charges. No $30.00 co-pay.
|Preventive Care Benefits for Children||Maximum allowance per periodic physical examination per age interval is $250, which includes examination, laboratory and inoculations. Limited to 19 periodic physical examinations at approximately each of the following intervals: Birth, 2, 4, 6, 9, 12, 15, 18 and 24 months, 3, 4, 5, 6, 8, 10, 12, 14, 16 and 18 years.|
|Physical Exam Benefits||100% of physician examination including X-ray and laboratory expenses (no deductible applied) up to a maximum reimbursement of $200 per employee and spouse as follows: Every 5 years up to age 35; every 2 years for ages 36 through 50; every year ages 51 or over.|
|Chiropractic Benefit||PPO ‑ 90% of the negotiated rate.
Non‑PPO – 70% of usual and customary charges.
|Supplemental Accident||100% of Usual and Customary Charges up to $500 per injury (no deductible applied); regular benefit schedule applies thereafter.|
|Physical and Other Therapies||PPO – 90% of the negotiated rate.
Non-PPO – 70% of usual and customary charges.
|Laboratory||Routine Lab – $10.00 co-pay for a preferred provider lab. This does not apply towards the deductible. This $10.00 co-pay does not apply to retirees on Medicare.
Non-PPO – 70% of usual and customary charges
|Prescription Drugs||Sav-RX Prescription Card – $15.00 generic and $30.00 for brand name on the Preferred Brand list for a 30-day supply. All other Brands $50.00. There is now a $100.00 calendar year deductible for all Brand named prescriptions.
Major Medical – 80% of usual and customary charges after deductible.
Sav-RX Mail Order Plan – The same as the Sav-RX Prescription Card Plan except for a 90-day supply of maintenance medications.
Medicare Retirees are NO longer eligible for Prescription drug coverage
|Skilled Nursing Facility||90% of charges incurred at a PPO skilled Nursing Facility and 70% at a non-PPO Skilled Nursing Facility. Confinement therein must start within 14 days of a Hospital stay. It must also be for continued treatment of the condition causing the hospital stay or any subsequent condition or complication related to the condition that caused the hospital stay or that arose as a result of the hospital stay.|
|Substance Abuse||Inpatient – $1,000 Hospital Admission Charge. For PPO providers 90% of contract rate. For Non-PPO providers 70% of UCR. Outpatient benefits are paid at 50% of Usual and Customary Charge. The maximum payable for outpatient benefits is $500. Hospitalization for acute alcohol or acute drug detoxification is limited to a maximum of 2 times per person lifetime.
Beat It! Plan – First time use is paid at 100% of inpatient or outpatient services approved by Beat It! Second time use- 80% of inpatient or outpatient services approved by Beat It! No benefits are provided after the second time use.
Benefits paid under the Beat It! plan and the Self-Funded plan have a combined lifetime maximum of $25,000.
- Change of Address
- CRX Enrollment Packet
- Disability Claim Form
- Enrollment Card
- HIPPA Authorization
- Life Insurance Claim Form
- Marriage Confirmation (requires notary) – English
- Marriage Confirmation (requires notary) – Spanish
- Pension Directive Form
- Retiree Enrollment Form
- Self-Funded Medical Plan Claim Form