Student Health Insurance
COVID-19 Update: Testing for COVID-19 is covered. Information about the Student Health Insurance as it relates to COVID-19 will continue to be updated. Please visit our COVID-19 Updates page for more information.
Tufts University students are required to have health insurance in accordance with Regulation 956 CMR 8.00 Section 8.05 under the State Law Chapter 15A, Section 18 and Tufts University policy. The university offers a comprehensive plan for undergraduate and graduate students on the Medford/Somerville and SMFA campuses and, if needed, their spouses and children through UnitedHealthcare StudentResources, one of the largest student health insurance providers in the country. Student health insurance is an economical policy. Once enrolled, you will have health insurance coverage for the year (Aug 20th to Aug 19th of the following year). The cost of the individual student plan is $4044 in 2022–2023. If you are enrolled under the student insurance you will also be charged the mandatory comprehensive health and wellness fee. For students in the Boston and Grafton campuses, please contact the Student Advisory and Health Administration Office.
If you have any questions about enrollment, eligibility, coverage, or other services please contact our Health Service Business Office or contact UnitedHealthcare StudentResources directly at 1-888-224-4752 or firstname.lastname@example.org.
Please contact your financial aid advisor if you need help covering the cost of the student health insurance.
MA Requirement to Purchase Health Insurance
As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL, or visit the Connector's website.
Minimum Requirements for Health Plan Comparable Coverage
Students attending universities in Massachusetts must have health insurance. National health care reform in the U.S. has some specific insurance benefit levels that impact requirements for students who want to waive the student health insurance plan with comparable coverage.
The health insurance charge, may be canceled if proof of comparable coverage from a U.S. carrier is submitted. If you are covered by a separate policy, please complete the Health Insurance Waiver on your SIS account.
The minimum requirements for acceptable health insurance coverage are:
- The plan must be administered in the U.S. International policies cannot be accepted, according to state requirements.
- Plan provides and maintains coverage for the full academic year, as well as evacuation and repatriation benefits.
- Plan must provide reasonably comprehensive coverage of health services, including primary care, emergency services, surgical services, hospitalization benefits, ambulatory patient services, and mental health services. These services must be reasonably accessible to the student in the area where the student is attending school.
- Plan provides unlimited coverage for prescriptions.
- Plan provides evacuation and repatriation.
- Plan does not limit coverage for a pre-existing condition.
- Plan does not impose an annual lifetime limit for essential health benefits.
- A health insurance plan that provides coverage through a closed network of providers, not reasonably accessible to the student in the area where the student attends school, for all but emergency services does not qualify for a waiver. Examples of closed networks include plans such as MassHealth Limited, the Children's Medical Security Program, the Health Safety Net, Kaiser Permanente Insurance, SHARP Health Plan, out-of-state Medicaid programs (e.g., Husky Health), and health plans based in Puerto Rico (e.g.,Triple-S, MCS, etc.).
Yearly Waiver for Health Insurance
The health insurance charge, may be canceled if proof of comparable coverage from a U.S. carrier is submitted. If you are covered by a separate policy, please complete the Health Insurance Waiver on your SIS account on the Bills & Balances tab. This waiver process is required every year.
|Enrollment Term||Waiver Site Dates|
|Academic Year (Fall/Spring/Summer)||June 1st - July 31st|
|Spring to Summer||November 1st - December 15th|
|Summer only||April 1st - May 9th|
Eligibility and Enrollment
Rates and Effective Dates
|Annual PY2022–2023||$4,044||20-Aug-2022 to 19-Aug-2023|
|Spring/Summer 2023||$2,559||1-Jan-2023 to 19-Aug-2023|
|Summer 2023||$1,076||15-May-2023 to 19-Aug-2023|
All full-time students are automatically enrolled in the student health insurance with United Healthcare StudentResources, unless proof of comparable coverage is furnished.
A change in your situation can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the "open enrollment period". Examples of Qualifying Life Event (QLE) are:
- Losing existing health coverage, including job-based, individual, and student plans
- Turning 26 and losing coverage through a parent’s plan
- Getting married or divorced
- Having a baby or adopting a child
- A student moving to or from the place they both live and work.
- Becoming a U.S. citizen
If you have lost coverage and would like to enroll, you can email us your request along with a letter from the insurance company showing you have lost coverage to the Health Service Business Office.
Overall Eligibility Requirements
All full-time students are automatically enrolled in the student health insurance plan, unless proof of comparable coverage is furnished. All part-time students taking fewer than 6 hours and all dissertation students are eligible to enroll in this insurance plan.
The student must actively attend classes for at least the first 31 days after the date for which coverage is purchased.
Home study, correspondence and enrollment in exclusively online courses do not fulfill the eligibility requirements that the student actively attend classes.
Tufts University employees are not eligible to enroll.
The Insurance Company maintains its right to investigate eligibility or student status and attendance records to verify that the Policy eligibility requirements have been met. If and whenever the Company discovers that the Policy eligibility requirements have not been met, its only obligation is refund of premium.
Eligibility for Undergraduate Students
All full-time undergraduate students are automatically billed the student health insurance. The health insurance charge, may be canceled if proof of comparable coverage from a U.S. carrier is submitted. If you are covered by a separate policy, please complete the Health Insurance Waiver.
Eligibility for Graduate Students
Graduate students in arts and sciences and in engineering are automatically enrolled in, and billed for, the Tufts student health insurance while full-time tuition is being charged. Once degree payment is complete and tuition is no longer charged, continuing graduate students are not automatically enrolled in the plan, but may purchase coverage directly from the email@example.com (recommended), or from UnitedHealthcare StudentResources, while they remain within the time limit for degree completion.
Award packages for full-time PhD students in the Graduate School of Arts and Sciences and for teaching and research assistants in the School of Engineering include payment of the Tufts student health insurance and the Tufts Health and Wellness Fee. For Graduate School of Arts and Sciences full-time PhD students, individual student health insurance will be paid for the first five years of study while tuition is being billed. For both the Graduate School of Arts and Sciences and the School of Engineering, coverage applies only to the enrolled student health plan offered by the Graduate School of Arts and Sciences and School of Engineering. Tufts will neither pay nor contribute towards other plans should a student elect not to take the Tufts coverage.
For Fletcher students, please visit this page.
Eligibility for International Students
International students are required to be covered by the student insurance plan through Tufts unless they meet the minimum requirements of plans as required by law.
Eligibility and Enrollment for Dependents (Spouse, Domestic Partner, and Children)
Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the student's legal spouse or Domestic Partner and dependent children under 26 years of age. See the Definitions section of this Certificate for the specific requirements needed to meet Domestic Partner eligibility.
The eligibility date for Dependents of the Named Insured shall be determined in accordance with the following:
- If a Named Insured has Dependents on the date he or she is eligible for insurance
- If a Named Insured acquires a Dependent after the Effective Date, such Dependent becomes eligible:
a. On the date the Named Insured acquires a legal spouse or a Domestic Partner who meets the specific requirements set forth in the Definitions section of this Certificate.
b. On the date the Named Insured acquires a dependent child who is within the limits of a dependent child set forth in the Definitions section of this Certificate.
Step-by-Step Guide to Enroll a Dependent
Study Abroad Programs
If you are doing a Tufts fall study abroad program, you will be billed for student insurance in November for the Spring semester. If you have comparable insurance and do not need student insurance, you should waive on SIS.
Students participating in non-Tufts study abroad programs are not eligible to enroll in the student health plan.
Refunds of premiums are allowed only upon entry into the armed forces.
Health Insurance Information for Graduating Students
Students enrolled in the student health insurance will have coverage until 19-August. With the academic year coming to a close, we wanted to share an updated Health Connector web page with information regarding health insurance options for graduating students: https://www.mahealthconnector.org/get-covered-grads. We hope this will be helpful as these students consider options.
This plan is underwritten by HPHC Insurance Company and is based on policy number 2021-202764-1. The policy is Non-Renewable One-Year Term Policy. This plan does not include any exclusions or limitations for pre-existing conditions. The student insurance does not require referrals or prior authorization prior to off-campus services.
Create an Account with UnitedHealthcare StudentResources
Start here, click the Create Account link at the bottom, and fill in the blanks! (You must first be enrolled in the student insurance plan before you can set up My Account.) You can use this step-by-step guide. Once you have an account you will be able to access your ID card, claims, EOBs, network providers, correspondence, reimbursement forms, etc.
Download the UHCSR app
Students can download the app by searching UHCSR in the App Store, Play Store. The app is free, and includes their ID card, provider search, claims search, and more.
The updates to the mobile app include a new look and feel, performance enhancements, and improved login functionality. New features include Action Center and Need Care options to help guide members to the best level of care for their situation.
Electronic ID Cards
Your insurance account will be updated and active approximately five days before the start of the policy period. Once your insurance account is active, you should be able to create a login name and password and download your insurance card. Most students enroll starting August 20th and can access their cards after August 15th.
Log in to My Account UHCSR and pick the ID card link to see a digital version. If you've got to have an actual card, you can request one from My Account too! You may also access your ID Card at any time via the UHCSR app. The UHCSR app will even allow you to email or fax your ID Card to your provider. App Store, Play Store
You do not need an ID card to be eligible to receive benefits. However, once you receive your ID card, present it to the provider to facilitate prompt payment of your claims. If you need medical care, please contact the Business Office or download a temporary ID card from UnitedHealthcare.
If you prefer to have a plastic card sent to you, you can request one by calling 1-888-224-4752, or by logging into My Account, clicking on "ID Cards" and following the prompts.
Get More Information about Your Online Account and Insurance Card
Dental Insurance (Optional Insurance)
Tufts University offers a voluntary and optional dental insurance plan through Delta Dental PPO Plus Premier Plan that is being offered for the next calendar year, the new policy year will run January 1, 2022–December 31, 2022. The deadline to enroll, re-enroll, or cancel is December 1, 2022. If you need to enroll outside of the enrollment period you can email firstname.lastname@example.org for more information. Students with a qualifying event will have the option to enroll mid-year with the appropriate documentation.
If a student does not enroll in this voluntary dental plan and there is a dental emergency, students can utilize the Tufts student dental clinic or pay out of pocket with a dentist of their choice.
For more information visit the Tufts University School of Medicine Dental Insurance page.
- Currently enrolled students: Students currently participating in the plan must re-enroll for the new policy year by December 1, 2022. Coverage will not be renewed unless a new enrollment form and payment is received by EBPA by the deadline.
- New enrollments: To enroll for the first time in The Delta Dental PPO Plus Premier Plan, complete the attached Enrollment Form and Payment Form and submit to EBPA by December 1, 2022.
- Students who enroll in coverage, are electing to be enrolled the entire calendar year. To enroll for the first time in The Delta Dental PPO Plus Premier Plan, complete the Enrollment Form and Payment Form and submit to EBPA by December 1, 2022.
- Please note: You are NOT automatically enrolled or billed for the dental plan since the plan is a voluntary plan. If you do not wish to enroll, no action is required.
When selecting a dentist, please make sure to select in the Delta Dental PPO network.
For more information, you can access the website for the Tufts School of Medicine.
Questions? Contact Gianna Vroom at 617-636-4073 or via email, or email email@example.com.
Coverage while on Medical Leave
Students who have purchased the insurance plan offered through UnitedHealthCare Student Resources for Tufts University and have met eligibility first will be able to continue on the plan while on medical leave for up to one year from the start of their medical leave. Please note that while on medical leave, a student will not be able to receive on-campus services, including Health Services and Counseling and Mental Health Services. For questions, please contact the Insurance Coordinator at firstname.lastname@example.org.
Coordination of Benefits
Coordination of Benefits (COB) are the rules to determine which health insurance is responsible for making the first payment when 2 or more health insurance plans are responsible for paying the same medical claim.
Per COB rules, the student health insurance will always be the primary payer.
This means that you present both insurance at the time of the visit and you explain the student insurance is your primary insurance. The provider will bill the student insurance first and anything that is not paid by the student insurance will be submitted to your secondary insurance for processing and payment. You will not know what is your payment responsibility until the claim has been processed by the secondary insurance.
Guidelines for Submitting Claims to UnitedHealthcare StudentResources
- The bill needs to include the diagnosis code (s), procedure code (s), date of service, and billed amount.
- Member must include receipt of payment for reimbursement.
- A claim form is not required for prescription claim reimbursement.
- Member needs to submit the receipt or computer printout within 90 days of the date of service with information which includes: medicine name, date of purchase, and price. If Insured doesn't provide this information within one year of the date of service, benefits for that service may be denied at UHCSR's discretion. This time limit does not apply if the Insured is legally incapacitated.
Coverage and Exclusions
For a comprehensive list, please refer to the Policy.
Coverage in the United States of America
UHCSR has providers in all 50 states. The Preferred Provider Network for this plan is HPHC Insurance Company Network. Preferred Providers can be found using the following link: UHC Options PPO - Harvard Pilgrim Joint Venture
Students have access to all Harvard Pilgrim Providers in MA, NH, and ME that includes over 135 hospitals and 28,000 doctors and clinicians.
Outside of MA, NH, and ME, students have access to the largest national network in the United States: UnitedHealthcare and Behavioral Health Network.
Options PPO and United Behavioral Health are the three proprietary national networks of UnitedHealthcare (UHC). Two out of three doctors and healthcare professionals and 96% of available general acute care hospital beds are contracted with UHC, resulting in local access to 98% of the US population. This network strength is leveraged to ensure that over $60 billion of health care spend results in high quality and cost effective providers, for the networks that may be assigned to your benefit plan.
Benefits While Abroad
The Student Health Insurance Plan provides worldwide coverage, whether studying abroad or traveling abroad. The plan provides the same benefits as if you were on campus. Additionally, United Health Care Global offers services for students while traveling. This includes but is not limited to referrals to foreign providers, pre-trip destination profiles, and medical evacuation in a medical emergency. To obtain these benefits, the member may contact United Healthcare Global outside the United States at 1-410-453-6330 or by email at email@example.com. Please be sure to use ID# 355751.
When traveling you should make sure you have your student insurance ID card. When traveling internationally, you may be asked to pay first for your services and then seek reimbursement.
Please visit the UnitedHealthcare website to download a claim form. Forms can be used for Medical or Pharmacy claims and should be submitted within 90 days of service. If you have any questions, please refer to your insurance guide.
Please review the Travel Abroad section for more information on immunizations.
Contact the Tufts International Safety and Operations Office to see if you are eligible to receive a travel insurance free of charge to you. You can also email them at firstname.lastname@example.org.
Please register your travel abroad using the Tufts Travel Registry.
Dental treatment is covered when services are performed by a physician for injury to sound, natural teeth.
Breaking a tooth while eating is not covered. Routine dental care and treatment to the gums are not covered.
Benefits will also be paid the same as any other Injury or Sickness for:
- Reduction of dislocation or fracture of the jaw or facial bone.
- Excision of a benign or malignant tumor of the jaw.
- Orthognathic surgery needed to correct a significant functional impairment that cannot be adequately corrected with orthodontic services.
- Removal of fully or partially impacted teeth.
- Facility charges for a serious medical condition (such as hemophilia or heart disease) that requires an Inpatient Hospital or day surgery facility admission in order for the dental care to be safely performed.
Exclusions and Limitations
- Cosmetic procedures and cosmetic medications are not covered.
- Dental treatment, except as described under Dental Treatment in the Policy.
- Elective Surgery or Elective Treatment.
- Health spa or similar facilities. Strengthening programs.
- Hearing aids. Other treatment for hearing defects and hearing loss except as detailed in the Policy.
- Immunizations, except as specifically provided in the Policy.
- Injury or sickness for which benefits are paid or payable under Workers' Compensation or Occupational Disease Law or Act, or similar legislation.
- Injury sustained by reason of a motor vehicle accident to the extent that benefits are paid or payable by any other valid or collectible insurance in excess of $1000.
- Injury sustained while participating, traveling or training for intercollegiate, or professional sport, contest or competition.
- Learning disabilities.
- Preventive care services which are not specifically provided in the Preventive Care Services benefits or except as specifically provided in the Policy, including: Routine physical examinations and routine testing, preventive testing or treatment, screening exams or testing in the absence of Injury or Sickness.
- Reproductive services for impotence and reversal of sterilization procedures, except as specifically provided in Benefits for Infertility.
- Routine eye examinations. Eye refractions. Eyeglasses. Contact lenses. Prescription or fitting of eye glasses or contact lenses. Vision correction surgery. Treatment for visual defects and problems. This exclusion does not apply when due to a covered injury or disease is in process, to benefits specifically provided in Pediatric Vision Services, and to contact lenses to treat keratoconus.
- Travel immunizations and travel medications are not covered.
Weight management services, treatment of sleep disorders, biofeedback, and smoking cessation medications are not covered.
Preventative Care Services - Oral Contraceptives
Benefits include all 18 FDA-approved contraceptive drugs and devices and office visits associated with contraceptive management. Please see the Health Resources & Services Administration's list of contraceptives. Benefits for hormonal contraceptives will be covered for up to 12-month supply when dispensed or furnished at one time for an Insured Person by a provider or pharmacy at a location licensed or otherwise authorized to dispense drugs or supplies. Contraceptive coverage may be excluded for certain exempt religious groups.
Preventative Care Services - Required
Required preventive care services are updated on an ongoing basis as guidelines and recommendations change. The complete list and current list of preventive care services covered under the health reform law can be found at https://www.healthcare.gov/what-are-my-preventive-care-benefits.
Pediatric Dental and Vision
Benefits are payable as specified in the Policy under Pediatric Dental Services Benefits and Pediatric Vision Care Services Benefits endorsements for all insured members under 19 years old.
Benefits for allergy testing and treatment are provided at the benefit levels specified in the Schedule of Benefits based on the type of covered service performed.
- Allergy testing (such as PRIST, RAST, and scratch tests).
- Allergy injections
- Allergy serum extracts.
Covered same as any other Sickness for chiropractor services, including, but not limited to:
- Diagnostic lab tests (such as blood tests).
- Diagnostic X-rays other than magnetic resonance imaging (MRI).
- Computerized axial tomography (CT) scans
- Other Medically Necessary imaging tests.
- Outpatient medical services (such as spinal manipulation).
Benefits are limited to reimbursement for three consecutive months for one family health club membership. Alternatively, benefits may be provided for reimbursement of up to 10 fitness classes by the Insured, or by any combination of the Insured and the Insured's Dependent(s) per Policy Year.
Benefits are limited to fees paid to:
- Privately owned or privately sponsored health clubs or fitness facilities
- YMCAs or YWCAs
- Jewish community centers
- Municipal fitness centers.
Benefits are not provided for fees or costs paid for:
- Personal training
- Country clubs
- Social clubs
- Sports teams or leagues
- Instructional dance studios
- Martial arts schools
Mental Health Benefits
If you have the Tufts student health insurance (UnitedHealthcare StudentResources, underwritten by Harvard Pilgrim Health Care), for academic year 2020-2021, the cost of care is $10/visit for an in-network/preferred provider provider. For "out-of-network" providers, you would be responsible for a $15/visit copay plus 20% coinsurance.
Temporomandibular Joint (TMJ) Disorder Services
Benefits for the diagnosis and treatment of temporomandibular joint (TMJ) disorder, limited to the following:
- Diagnostic X-Rays
- Surgical repair or intervention
- Non-dental services to diagnose and treat TMJ disorder.
- Splint therapy, including measuring, fabricating and adjusting the splint.
- Physical therapy
Benefits do not include:
- Services or supplies for TMJ disorder that are not caused by or result in a specific medical condition.
- Appliances, other than mandibular orthopedic repositioning appliance (MORA).
- Services, supplies, or procedures to change the height of teeth or restore occlusion (such as bridges, crowns, or braces.
Preferred Provider Network
The doctors and other health care providers who belong to the network covered by the UnitedHealthcare student health insurance plan are called “preferred providers.” They include general practitioners and internists, as well as specialists, hospitals and other health care facilities. Their network extends across the country, you'll find preferred providers locally as well as nationally.
To receive the highest level of benefits from the Plan, you should obtain covered services from Preferred Providers whenever possible. The easiest way to locate Preferred Providers is through the plan's website at www.uhcsr.com/tufts. The website will allow you to easily search for providers by specialty and location. The Preferred Provider Network for this plan is HPHC Insurance Company Network. Preferred Providers can also be found using the following link: UHC Options PPO- Harvard Pilgrim Joint Venture. The network search is also available from My Account UHCSR and from the UHCSR app. App Store, Play Store.
You may also call the UHCSR Customer Service Department at 1-888-224-4752, toll free, for assistance in finding a Preferred Provider.
Definition: Preferred providers are those doctors and facilities that have agreed to provide a negotiated discount to members of UnitedHealthcare insurance plans. This may lower your out of pocket costs for services received.
Please note that any services received outside of the Medford Campus and less than 50 miles away from campus need a referral. Please contact email@example.com and include the type of provider you are visiting, the date of the appointment and the reason for the visit.
SMFA Students Only
If you are an SMFA student and have student insurance, you can:
- Be seen by a clinician at Health Service in the Medford/Somerville campus at no charge
- Visit Atrius Health in Kenmore Square with a $20 copay at the time of the visit. Labs, X-rays and other ancillary services will be covered at 85% (15% coinsurance).
Prescription Drug List
Means a list that categorizes into tiers medications or products that have been approved by the U.S. Food and Drug Administration. This list is subject to UHCSR's periodic review and modification (generally quarterly, but no more than 6 times per calendar year). The Insured may determine to which tier a particular Prescription Drug Product has been assigned through the internet at www.uhcsr.com/tufts or call UHCSR Customer Service at 1-855-828-7716.
If the Insured is directed to a Designated Pharmacy and chooses not to obtain their Prescription Drug Product from a Designated Pharmacy, the Insured may out-out of the Designated Pharmacy program through the internet at www.uhcsr.com/tufts or by calling Customer Service at 1-855-828-7716. If the Insured opts-out of the program and fills their Prescription Drug Product at a non-Designated Pharmacy but does not inform UHCSR, the Insured will be responsible for the entire cost of the Prescription Drug Product.
Specialty Prescription Drug Products
UHCSR designates certain Network Pharmacies to be Preferred Specialty Network Pharmacies. UHCSR may periodically change the Preferred Specialty Network Pharmacy designation of a Network Pharmacy. These changes may occur without prior notice to the Insured unless required by law. The Insured may determine whether a Network Pharmacy is a Preferred Specialty Network Pharmacy through the internet at www.uhcsr.com/tufts or by calling UHCSR Customer Service at 1-855-828-7716.
Prescriptions: Plan for Your Trip
Do you have enough medication to last through your trip? It is best to get all the refills before you travel.
Not eligible for refills yet? If you need to refill a prescription before you go on vacation, but it's not eligible for a refill yet, ask for an exception called a vacation override to get it filled before you leave town. You can request the vacation override at the pharmacy directly or submit a request for the override at firstname.lastname@example.org.
The following information should be provided in the email:
- SUBJECT LINE: Vacation Override – School Name
- The body of the email should contain the following:
- Member Demographic Information
- Copy of Paid Itinerary
- Member Name
- Date of Birth
- UHCSR 7 digit Identification Number
- Name of Drug[s]
- Duration-Number of Month[s]
- Student Contact Number
- Pharmacy Contact Number
The pharmacy benefit manger will advise if member obtains override for medications and the duration. Limitations and exclusions, if any, will be provided once reviewed by pharmacy benefit manager.
If you need information about a prescription, you can check the UHCSR Prescription Rx Drug List.
Please be aware that the insurance is not able to provide an override for monthly supplies past the coverage termination date (August 19) at the time of request.
Mail-Order Pharmacy for 90-day Supplies with OptumRx
If the student would like to order 90-day supplies for their prescriptions, please follow these steps:
- Tell your provider you would like to do a mail order for a 90-day supply prescription. The provider will submit your electronic prescription to OptumRx in Carlsbad, CA.
Providers can escribe, fax or verbally give the prescription over the phone. Some controlled substances required a hard copy to be mailed in. If a hard copy is needed, the hard copy can be found on OptumRx.com under Forms option at the bottom of the page.
- The student contacts OptumRx to create an account at 1-800- 562-6223 and provides the following information:
a. Student name, date of birth and address where the medication will be mailed.
b. Doctor's name and telephone: 617-627-3350, fax: 617-627-3592
c. Credit card information to pay for copays. OptumRx accepts all major credit cards (Visa, MasterCard, AmEx, Discover, etc.)
Additional contact information:
- Optum HDP Fax 800-491-7997
- Optum RX Specialty Fax 877-342-4596
- Doctor Line 800-791-7658
Prescription Drug Coverage - Cost Sharing
Preferred Retail Cost Sharing (In-Network Pharmacies)
|Drug Tier||30-day supply||60-day supply||90-day supply|
|Tier 1 - Your Lowest-Cost Option||$25||$50||$75|
|Tier 2 - Your Midrange-Cost Option||$50||$100||$150|
|Tier 3 - Your Highest-Cost Option||$75||$150||$225|
Out-of-Network Retail Cost Sharing
|Drug Tier||30-day supply|
Tier 1, Tier 2, and Tier 3
$20 copay for generic drugs
$45 copay for brand-name drugs
Mail-Order Cost Sharing (In-Network Pharmacy: OptumRx)
|Drug Tier||90-day supply|
|Tier 1 - Your Lowest-Cost Option||$62.50|
|Tier 2 - Your Midrange-Cost Option||$125|
|Tier 3 - Your Highest-Cost Option||$187.50|