Benefit Change Highlights
Comprehensive Choice POS II Plan Highlights
Prescription Drugs
Effective January 1, 2016
2015
In-Network
Pharmacy Administrator
Non-Network
Caremark
In-Network
Non-Network
OptumRx
See Open Enrollment booklet for
additional information
HDHP Aetna Choice POS II Plan Highlights
Effective January 1, 2016
2015
In-Network
Calendar Year Out-of-Pocket Maximum
Pharmacy Administrator
Non-Network
$5,000 / Employee Only
$10,000 / Employee + Dependents
In-Network
Non-Network
$4,500 / Employee
Only
$6,750 / Employee +
Dependents
$6,750 / Employee
Only
$10,125 / Employee +
Dependents
Family OOP applies to all members
Family OOP applies to all members
Caremark
OptumRx
See Open Enrollment booklet for
additional information
2015
Effective January 1, 2016
Basic Life/AD&D
Basic Life benefit
100% Employer-Paid Options:
2x annual base salary up to maximum of
$1,500,000
100% Employer-Paid Options:
1) $50,000 benefit amount
2) 2x annual base salary up to maximum of
$1,500,000
Buy Up Option:
3x annual base salary available on age-rate
basis
Buy Up Option:
3x annual base salary available on age-rate
basis (rate sheet available on the Open
Enrollment system)
Voluntary Life/AD&D
Carrier
2015
Effective January 1, 2016
Adam’s Group Insurance
Prudential
New and existing enrollees under the Voluntary Life and/or AD&D
must complete a Prudential Beneficiary Form
CA FLEX EMPLOYEES • 2
Additional Benefit Change Highlights
CVS Caremark to OptumRx effective January 1, 2016
Frequently Asked Questions
The Scripps Research Institute is working to make this as seamless a transition as possible for participants with
minimal disruption for members. Below please find some commonly asked questions regarding the transition. For
more information, please go to the TSRI intranet site.
1.
Will I be receiving a new ID card?
Yes, OptumRx will be sending out new ID cards prior to January 1st.
2.
I am currently enrolled in the Aetna CA HMO. Does this change apply to me?
No, it does not. This change applies to participants enrolled in the Comprehensive Choice POS II and HDHP Aetna
Choice POS II plans.
3. Will I be receiving anything in the mail?
Prior to January 1st, you will receive a welcome kit which will include your new ID card as well as a welcome letter and brochures to ease you into the transition.
4. Can I access my information online?
Prior to January 1st, members may access the OptumRx Public Portal at
https://ctr.benefits.catamaranrx.com/rxpublic/portal/memberMain?customer=CTRNS for basic information.
Effective January 1st, members may access the Member Portal that
will contain specific plan information. Members may register
and log on at optumrx.com/myCatamaranRx.
A mobile app is also available for members by scanning the
QR Code to the right or downloading the mobile app through
Apple App StoreSM or Google PlayTM.
5.
My medication requires prior authorization. Will I need to go through this process again?
Prior authorizations (unless expired or near expiration) will automatically transfer from CVS Caremark to
OptumRx.
6. I am currently signed up for mail order. Will I need to sign up through OptumRx?
For most members, mail order prescriptions will automatically transfer to OptumRx. However, for those with
expired or close to expiring prescriptions, or prescriptions for controlled substances, members will need to
sign up for mail order directly with Optum Rx. A mail order form will be included in the welcome kit or you may
complete the process online through your member account.
CA FLEX EMPLOYEES • 3