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2021 LivingWell PPO

The LivingWell Preferred Provider Organization (PPO) is a traditional health plan.

            • You will have a higher premium with this plan option because there are co-payments for certain services, rather than co-insurance.
            • Your co-pays will not apply to your deductible, but will apply to your out-of-pocket maximum.
            • See page 26 in the Benefits Selection Guide (BSG) for more information on prescription benefits.
            • You will have a co-payment for all prescriptions tiers.
            • Your pharmacy benefit preferred drug listing — sometimes called a formulary — is the Value Formulary administered by CVS Caremark. 
            • Your medical out-of-pocket maximum is separate from your pharmacy out-of-pocket maximum, and they accumulate separately.
            • You must complete the LivingWell Promise.

Click here to see the actual cost of your prescription(s) from a participating pharmacy of your choice. In the LivingWell PPO plan, if you receive a 30-day supply you are responsible for a $15 or $40 copay. If you receive a 90-day supply, either at a participating retail pharmacy or through CVS mail order pharmacy you will be responsible for a $30 or $80 copay.