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Medical/Prescription Drugs
Your State Medical/Prescription Drugs Plan

CVS Caremark will be the pharmacy benefit manager for individuals enrolled in a State of Delaware non-Medicare health plan, administered by Highmark Delaware or Aetna effective July 1, 2021. It is important to remember:

  • Prescriptions CAN be filled at Walgreens, Rite-Aid, CVS and other retail pharmacies.
  • The current copay structure will NOT change.
  • Prescription drug savings programs for generic, maintenance, mail order and diabetic medications/supplies will remain in place.
  • You must present your NEW CVS Caremark ID Card to get your prescriptions on and after July 1, 2021.

Medicare-eligible retirees will transition on January 1, 2022. More information will be provided to Medicare members during 2021 Fall Open Enrollment.


The chart below shows a general comparison of the Plan options offered by the State. For more comprehensive information, refer to your open enrollment booklet and other materials available online at dhr.delaware.gov/benefits/.

For more details about how eligible expenses are covered, refer to your Summary Plan Description, available online at dhr.delaware.gov/benefits.

Highmark Health Plans - https://dhr.delaware.gov/benefits/education/highmark.shtml

Aetna Health Plans - https://dhr.delaware.gov/benefits/education/aetna.shtml

CVS Caremark Prescription Plan - https://dhr.delaware.gov/benefits/cvs/index.shtml

For more details about how eligible expenses are covered, refer to your Summary Plan Description, available online at https://dhr.delaware.gov/benefits/education/index.shtml

Express Scripts Customer Service: 1-800-939-2142 or 1-800-282-2881

 

For more information on the changes for the coming year, click here.

  First State Basic Plan CDH Gold Plans HMO Plans Comprehensive PPO
Carrier Highmark Blue Cross Blue Shield Delaware Highmark Blue Cross Blue Shield Delaware and Aetna Highmark Blue Cross Blue Shield Delaware (BlueCare HMO) and Aetna Highmark Blue Cross Blue Shield Delaware
Type of Plan Preferred Provider Organization (PPO) Consumer Directed Health (CDH) Plan Health Maintenance Organization (HMO) Preferred Provider Organization (PPO)
Percentage of Premiums State Pays 96% 95% 93.5% 86.75%
Percentage of Premiums You Pay 4% 5% 6.5% 13.25%
Plan Features Lowest premiums offered. Freedom to visit providers in or out-of-network, but benefits are greater in-network. After you meet an annual deductible, plan begins to pay benefits. Most in-network covered services are paid at 90%. You pay the other 10%. Low premiums. Freedom to visit providers in or out-of-network, but benefits are greater in-network. Plan includes a State-Funded health reimbursement account (HRA) that can be used to pay for eligible expenses, including your deductible. Deductible is higher than other plans, but is mostly covered by the HRA. If you reach your out-of-pocket maximum, plan pays 100% of all costs for the rest of the plan year. If you have money left in your HRA, it rolls over year-to-year. Slightly higher premiums. Must visit providers within the network to receive coverage, must designate a Primary Care Physician (PCP) and obtain referrals to see most specialists. No deductibles or coinsurance; most services require a flat co-payment for services. Highest premiums. Freedom to visit providers in or out-of-network, but benefits are greater in-network. No deductible in-network. Most in-network covered services are paid at 100% in-network after applicable copayment.
In-Network Deductible $500 individual

$1,000 family		 $250 individual ($1,500 minus State's contribution to HRA of $1,250)
$500 family ($3,000 minus State's contribution to HRA of $2,500)		 None None
Preventive Care Paid at 100%, no deductible Paid at 100%, no deductible $15 copay (office visit) $20 copay (office visit)
Office Visits
Primary Care Physician
Specialist
Paid at 90% after deductible Paid at 90% after deductible
 
$15 copay
$25 copay
 
$20 copay
$30 copay
Copayments* No No Yes Yes
In-Network Coinsurance for Most Services* Plan pays 90% after deductible Plan pays 90% after deductible N/A N/A
Out-of-Network Coverage* Plan pays 70% after deductible of $1,000 per individual or $2,000 per family Plan pays 70% after deductible None available Plan pays 80% after deductible of $300 per individual or $600 per family
Out-of-Pocket Maximum
(in-network, excluding deductibles)		 $2,000 individual
$4,000 family		 $3,000 individual
$6,000 family		 None None

* For more details about how eligible expenses are covered, refer to your Summary Plan Description, available online at www.ben.omb.delaware.gov/medical.

 

Coverage for Adult Children Under Age 26 Effective July 1, 2011

Effective July 1, 2011, the State Group Health Insurance Plan (GHIP) will include coverage for adult children up to age 26. Your adult dependent children may be enrolled in the plan, up to age 26, with no requirement or restriction on marital, employment, student, resident or tax status. In other words, you may enroll an otherwise eligible adult child, up to age 26, whether or not the child is married, employed, a student, a tax eligible dependent or living with you.* Coverage of eligible adult children may continue until the end of the month in which the adult child turns age 26.

* The new federal health insurance law relating to dependent coverage of children requires the State of Delaware to offer group health coverage to an employee's children who have not reached age 26.

 
   
Related Forms
Spousal Coordination of Benefits Form
CVS Reimbursement Form
State of DE 2016-2017 Enrollment Brochure
   
Related Links
Aetna
Highmark Delaware
Statewide Benefits
   







Disclaimer: New Castle County Vocational Technical Benefits Online provides only an overview of your benefits from New Castle County Vocational Technical School District and The State of Delaware. New Castle County Vocational Technical School District and The State of Delaware reserve the right to amend or to terminate any benefit plan at any time, with or without notice. Review more important legal information about your benefits plans.

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