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Pensions and Benefits
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM (SEHBP)
RETIREE PRESCRIPTION DRUG COPAYMENTS

LOCAL EDUCATION RETIREE COPAYMENT AMOUNTS

Click for State and Local Government Retiree Copayments

Plan Year 2012 prescription drug copayments for Retired Group SEHBP members.

Retiree prescription drug copayments are based on the medical plan in which the retiree is enrolled.

NJ DIRECT10 or 15 | Aetna HMO or Cigna HMO | 1525 Plans | 2030 Plans | High Deductible Plans

NJ DIRECT10 or NJ DIRECT15

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-30 days $9 $20 $39
31-60 days $18 $40 $78
61-90 days $27 $60 $117


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-90 days $5 $29 $49

Under NJ DIRECT10 or NJ DIRECT15 there is an annual maximum out-of-pocket amount for prescription drug copayments of $1,318 per person. Once a person has paid $1,318 in copayments in a calendar year, that person is no longer required to pay any prescription drug copayments for the remainder of that calendar year. Prescription drug copayments are not eligible for further reimbursement by NJ DIRECT10 or NJ DIRECT15 and do not apply to medical plan deductibles or coinsurance.

Aetna HMO or Cigna HealthCare HMO

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-30 days $5 $12 $24
31-60 days $10 $24 $48
61-90 days $15 $36 $72


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-90 days $5 $17 $29

Under Aetna HMO or Cigna HealthCare HMO there is an annual maximum out-of-pocket amount for prescription drug copayments of $1,318 per person. Once a person has paid $1,318 in copayments in a calendar year, that person is no longer required to pay any prescription drug copayments for the remainder of that calendar year. Prescription drug copayments are not eligible for further reimbursement by Aetna HMO or Cigna HealthCare HMO and do not apply to medical plan deductibles or coinsurance.

NJ DIRECT1525, Aetna1525, or Cigna1525

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-30 days $7 $16 $35
31-60 days $14 $32 $70
61-90 days $21 $48 $105


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-90 days $5 $40 $88

Under NJ DIRECT1525, Aetna1525, or Cigna1525 there is an annual maximum out-of-pocket amount for prescription drug copayments of $1,318 per person. Once a person has paid $1,318 in copayments in a calendar year, that person is no longer required to pay any prescription drug copayments for the remainder of that calendar year. Prescription drug copayments are not eligible for further reimbursement by NJ DIRECT1525, Aetna1525, or Cigna1525 and do not apply to medical plan deductibles or coinsurance.

NJ DIRECT2030, Aetna2030, or Cigna2030

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-30 days $3 $18 $46
31-60 days $6 $36 $92
61-90 days $9 $54 $138


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-90 days $5 $36 $92

Under NJ DIRECT2030, Aetna2030, or Cigna2030 there is an annual maximum out-of-pocket amount for prescription drug copayments of $1,318 per person. Once a person has paid $1,318 in copayments in a calendar year, that person is no longer required to pay any prescription drug copayments for the remainder of that calendar year. Prescription drug copayments are not eligible for further reimbursement by NJ DIRECT2030, Aetna2030, or Cigna2030 and do not apply to medical plan deductibles or coinsurance.

NJ DIRECT HD4000, Aetna HD4000, or Cigna HD4000

Under the High Deductible (HD) Health Plans prescription drug benefits are subject to the HD plan deductible and coinsurance. See your plan handbook or contact you HD Plan directly for details.


If you have any questions regarding this information, contact the Office of Client Services at
(609) 292-7524 or send an e-mail using the "contact us" link below.

 
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