Citi Benefits Handbook
Your Out-of-Pocket Maximum
There is a separate prescription drug out-of-pocket maximum ($1,500 per individual and $3,000 per family) under the In-Network Only Plan and Choice Plan. This feature is designed to help protect you from a large annual expense for prescription drugs, since this is the most you will ever pay for prescriptions per year. Once you reach the out-of-pocket maximum, the Program will pay 100% of your covered prescription costs for the remainder of the plan year.
Keep in mind, you will still pay 100% of the prescription cost after the out-of-pocket maximum is met after the third fill of a covered maintenance medication through a non-CVS pharmacy.
There is a combined medical and prescription drug out-of-pocket maximum under the High Deductible Plan with HSA of $5,000 individual and $10,000 ($6,850 per individual) family in-network ($7,500 individual and $15,000 family out-of-network). This amount includes your medical/prescription drug deductible, coinsurance and copays. This represents the most you will have to pay out of your own pocket in a plan year.
Note: For in-network services under the High Deductible Plan with HSA, the family out-of-pocket maximum is $10,000, but each of your covered family members has an individual out-of-pocket maximum of only $6,850. After reaching that amount, your plan will cover 100% of that individual's in-network health care expenses for the rest of the year. Once the $10,000 family in-network out-of-pocket maximum is met, your plan will cover 100% of the entire family's in-network health care expenses for the rest of the year.
For answers to your questions about the out-of-pocket maximum, call CVS Caremark Customer Care at 1 (844) 214-6601.
Caremark Cost Savings Program
Through the Caremark Cost Saver program, you will receive automatic access to discounted prices on generic prescription drugs through GoodRx. When you submit a prescription to be filled, your Caremark benefits and any available GoodRx discounts will be applied to ensure you pay the lowest available price. The amount you pay will automatically be applied to your plan's prescription deductible and out-of-pocket maximum. This program applies to generic medications only and will be part of the prescription drug coverage included with the In-network Only Plan, Choice Plan, and High Deductible Plan with HSA. Note: The Caremark Cost Saver program is not available in Florida.