How to be a Smart Benefits Consumer
We all understand what it means to be a savvy consumer – to make informed choices to get the best value for our money. Applying the same savvy to your benefits plan can make your coverage go further, save unnecessary out-of-pocket expenses. Here are a few things you can do to get more from your Plan:
If your spouse has coverage under an employer benefits plan, you may be able to coordinate benefits. Here’s how!
Use your HCSA to pay for eligible health-related expenses not otherwise covered by the Plan. This includes out-of-pocket costs or expenses beyond your annual maximums. Discover your HCSA.
When choosing paramedical practitioners and medical service providers, look for providers with reasonable and customary prices that are in the normal range of fees for your area. Learn more about “Reasonable & Customary”
Pharmacy fees (including dispensing fees and drug mark-ups) can vary significantly depending on where you fill your prescription. The Plan has a [$8 cap for P/VP, $8 cap for CAEAS-ECAB] on dispensing fees. If your pharmacy charges more than this, the difference will come out of your pocket so it may be time to look around, ask what different pharmacies in your area charge, and consider taking advantage of lower-priced alternatives. If you do decide to switch pharmacies, in most cases, your new pharmacy can have your prescription history transferred from your old pharmacy to make the transition easier for you.
Most people don’t realize that it’s possible to make individual arrangements with the pharmacy manager. You can explain the Plan’s limits on dispensing fees (per the above), and then ask if they would be willing to waive some or all cost differences between what they charge and what the plan covers. If they agree to a special arrangement, make sure it’s noted on your file.
You can usually get maintenance drugs (medications you take regularly for chronic conditions) in a 90- or 120-day supply rather than filling your prescription every month. Not only will this help ensure you don’t exceed the dispensing fee frequency limit, but it also means you’ll need to make fewer trips to the pharmacy.
The Plan’s generic substitution provides reimbursements based on the cost of the lowest-priced interchangeable drug. You can help to save money and make your benefits more affordable by asking your doctor about generic alternatives.
For everything you need to know about your benefits:
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