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For Coverage Questions

Prescription drug coverage
Contact OptumRX 
Phone: 1-800-509-9891
Web: OptumRx.com

Medical coverage
Go to gehealthcarehub.com for a listing of your Health Plan Administrator's phone numbers, web sites and mobile apps

For Health Care Claims and Benefit Questions
Contact Health Coach from GE
Phone: 1-866-272-6007

For Eligibility Questions
Contact the GE Benefit Center
Phone: 1-800-252-5259

Your Rights and Protections Against Surprise Medical Bills
Learn more 

 

Prescription Drugs - 2022

< Back to GE Health Choice Plan Information


Overview


Click here to learn more about changes to Prescription Drugs in 2023.

 
 

Plan Details

All three medical care options provide the same basic prescription coverage once you meet your annual deductible.

Your Prescription Drug Coverage
The chart below shows what you pay under the Prescription Drug benefit coverage under all three medical care options. 

 
Retail*                                                       Mail Order*
In-network: Up to a 30-day supply In-network: Up to a 90-day supply***       
Out-of-network: No coverage Out-of-network: No coverage
Generic Drugs: $12 co-pay after annual deductible; 90-day supply**
$24 co-pay after annual deductible		 Generic Drugs: $24 co-pay after annual deductible
Brand Name Drugs: 30% co-insurance, after annual deductible; 90-day supply 20% co-insurance, after annual deductible Brand Name Drugs: 20% co-insurance, after annual deductible
Specialty Drugs: $150 co-pay, no annual deductible for Options 1 & 2, Option 3 after annual deductible Specialty Drugs: $450 co-pay, no annual deductible for Options 1 and 2, Option 3 after deductible
Targeted Drugs:  $12 co-pay, no annual deductible for Options 1 & 2, Option 3 after annual deductible; 90-day supply $24 co-pay, no annual deductible for Options 1 & 2, and Option 3 after annual deductible Targeted Drugs: $24 co-pay, no deductible for Options 1 & 2, Option 3 after annual deductible
*Brand/generic difference applies.
**Get a 90-day supply for eligible medications through OptumRx mail order.
***OptumRx can now accept some manufacturers coupons/copay cards at mail order. Contact OptumRx to see if your coupons/copay cards are eligible for mail order.    
 
  • Statins: Select generic statin drugs to treat high cholesterol will be covered at 100% and are not subject to your annual deductible. Select statins are: Atorvastatin, Simvastatin, Pravastatin, Rosuvastatin, Lovastatin, Fluvastatin.
  • Select drugs used to treat opioid addiction are covered at 100% and are not subject to annual deductible for those enrolled in Options 1 & 2. Option 3 covered at 100% after annual deductible is met.
  • Select generic drugs to treat high blood pressure will be covered at 100%. Not subject to annual deductible for those enrolled in Options 1 & 2.  Option 3 covered at 100% after annual deductible is met.
Retail/mail in-network: 100%, no annual deductible
Out-of-network: No coverage

Glucose monitors - One per year
Insulin - Applicable prescription drug co-pays and co-insurance apply
Syringes/needles (lancets, test strips, alcohol swabs) and related insulin pump supplies (e.g. cartridges, reservoirs and tubing)
Insulin pumps (available through your medical plan or prescription drug plan)

Diabetic supplies (glucose monitors, syringes/needles and related supplies, insulin pump and related supplies) are covered at 100% and must be purchased through a pharmacy in the OptumRx network. For Options 1 and Option 2 you do not have to meet your annual deductible before coverage begins. With Option 3, coverage begins after you meet your annual deductible.

Continuous glucose monitors (CGMs) and related CGM supplies (for example, the sensor, transmitter and receiver) are available through your medical plan or prescription drug plan and covered at 80%, subject to the annual deductible.
 
You are responsible for paying the difference in cost between a generic and brand name drug, plus the co-pay/co-insurance, unless the brand name drug is medically necessary. Amounts paid in excess of the cost of the generic equivalent when a brand name is not medically necessary will not count toward either your annual deductible or out-of-pocket maximum.
Coverage when obtained through your OptumRx prescription drug benefits and OptumRx Specialty Services.

Specialty drugs typically include injectable, infused, oral, or inhaled drugs that generally require special storage or handling and close monitoring of the patient's drug therapy. These drugs are often, but not always, high-cost. Most specialty drugs are used to treat chronic diseases.

GE Health Choice Options 1 and Option 2 will not subject these drugs to an annual deductible; however, there is a fixed co-pay – $150  for a 30-day supply, $450 for a 90-day supply (through mail-order). With Option 3, you must meet your annual deductible before these drugs will be covered at the co-pays listed above.

Visit OptumRx for more information
Targeted drugs are generally for specific conditions such as diabetes. For a list of targeted drugs go to optumrx.com

GE Health Choice Options 1, and Option 2 will not subject these drugs to an annual deductible and co-insurance maximum; however, there is a fixed co-pay – $12 for a 30-day supply, $24 for a 90-day supply (through mail-order). With Option 3, you must meet your annual deductible before these drugs will be covered at the co-pays listed above.

Visit OptumRx for more information
Certain over-the-counter (OTC) and prescription drugs prescribed by a doctor will be covered at 100%, based on USPSTF recommendations. Age and gender restrictions apply.
  • Aspirin to prevent cardiovascular disease (CVD)
  • Iron supplements in children
  • Chemoprevention of dental caries (cavities) – Fluoride supplementation
  • Certain tobacco and smoking cessation products for adults
  • Certain immunizations as recommended by the USPSTF
  • Colonoscopy prep drugs
Receive care at a negotiated rate of $20/copay per visit for Options 1 & 2 (Option 3 must meet annual deductible before $20 copay applies ($50 per visit while in deductible phase)) at select CVS pharmacies that have a participating convenience care clinic within their location.  Visit Convenience Care Advantage to learn more.