2025 Benefits Open Enrollment: Medical and Pharmacy

On this page:

• Medical and Pharmacy Plans
• Prescription Drug Coverage
• Definitions

Medical and Pharmacy Plans

Benefit-eligible employees (75% FTE or higher) can elect medical coverage with Anthem with or without electing dental and/or vision coverage.

Eligible spouses not enrolled in dental and/or vision coverage may enroll in medical coverage if the employee is enrolled as the policyholder and the spouse meets the eligibility requirements of the Spousal Insurance Coverage Policy.

Eligible children (up to age 26) not enrolled in dental and/or vision coverage may enroll in medical coverage if the employee is enrolled as the policyholder.

Having access to high-quality, comprehensive medical plans is important. Wright State offers three medical plans through Anthem Blue Cross Blue Shield—two copay-based plans and one High Deductible Health Plan (HDHP)—so you can choose the plan that works best for you. All plans cover in-network preventive care at no cost to you, as well as prescription drug benefits and behavioral health services.

Your 2025 medical plan options include:

Blue High-Performance Network

A copay-based plan that requires you to receive medical care from a specific network of providers in Ohio, Kentucky, and Indiana. Out-of-network services are not covered under this plan, except for emergencies. The plan has lower employee premiums and copays when obtaining services and a lower total cost for both employees and Wright State University.

• Find Blue HPN In-Network Providers (PDF)

High Deductible Health Plan

This plan offers both in and out-of-network coverage. Services are subject to a deductible and coinsurance up to the out-of-pocket maximum. When in-network services are received, your deductible and coinsurance amounts are lower than when services are obtained outside of the network. The plan has the second-lowest employee premiums, and Wright State’s annual contribution to the Health Savings Account remains unchanged from last year ($500 for employee-only coverage and $1,000 for all other coverages).

• Find HDHP In-Network Providers (PDF)

PPO 80/20 Plan

A copay-based plan that offers both in- and out-of-network coverage. Certain services require a copay, and others are subject to deductible and coinsurance up to the out-of-pocket maximum. When in-network services are received, your deductible and coinsurance amounts are lower than when services are obtained outside of the network.

• Find PPO 80/20 In-Network Providers (PDF)

Prescription Drug Coverage

All university-sponsored medical plans include prescription drug coverage. The Essential Drug List - 4 Tier Drug Plan (PDF) is the university’s list of generic, brand, and specialty drugs that are covered by the plan.

• Tier 1 drugs have the lowest cost share.
• Tier 2 drugs have a higher cost share than Tier 1.
• Tier 3 drugs have a higher cost share and may include drugs that were recently approved by the Food and Drug Administration (FDA).
• Tier 4 drugs have the highest cost share and usually include specialty brand drugs. Tier 4 may also include drugs recently approved by the FDA or specialty drugs used to treat serious, long-term health conditions and may need special handling.

Prescriptions can be filled at any in-network retail pharmacy, including CVS, Walmart, Kroger, Sam’s Club, Costco, Dayton Children’s Hospital, etc. Walgreens pharmacy is not in-network.

Anyone taking long-term maintenance prescriptions on the Maintenance Drug List (PDF), such as those for heart disease, high blood pressure, etc., is required to fill these prescriptions in 90-day quantities from an Rx Maintenance 90 Pharmacy Network (PDF) or by mail through Anthem’s mail service pharmacy, CarelonRx. Maintenance prescriptions can be filled in a 90-day supply, meaning fewer trips to the pharmacy by placing only four medication orders per year. Plus, you’ll save money by doing so.

Rx Maintenance 90 Pharmacy Network (PDF) Quick References:

• Please refer to the “key’ at the bottom of each page.
• Look for the "black bullet point," which designates a participating Rx Maintenance 90 Pharmacy Network.
• Information pertaining to Ohio begins on page 511.

Definitions

View the full glossary of commonly used health coverage and medical terms.

• Covered Services: A medically necessary service or supply for which the benefit plan will reimburse expenses according to the plan’s limits.
• Copay: A copay is a fixed dollar amount (for example, $20) you pay for a covered health care service, such as a primary care office visit, at the time you receive the service. The amount can vary by the type of service.
• Deductible: Your deductible is the amount you owe for certain medical services before your medical plan begins to pay (except free preventive services). For example, if your deductible is $1,800, your plan will not pay anything until you have paid $1,800 out-of-pocket for certain covered services subject to the deductible. The deductible may not apply to all services.
• Coinsurance: Coinsurance refers to your share of the cost of certain covered medical services, calculated as a percent of the allowed amount for the service (for example, 20%). You pay coinsurance in addition to any deductible you owe for your plan. The health plan pays the rest of the allowed amount.
• Generic Prescription Drug: A prescription drug that is produced by more than one manufacturer. It is chemically the same as the brand and usually costs less than the brand name prescription drug for which it is being substituted and will produce comparable effective clinical results.
• Brand Name Prescription Drug: A prescription drug that has been patented with the brand name and is produced by the original manufacturer under that brand name.
• Specialty drugs: High-cost prescription medications are used to treat complex, chronic conditions. Specialty drugs sometimes require special handling and administration (typically injection or infusion).

 

Disclaimer: The benefits information contained on this site provides a summary for employees of Wright State. This information does not list all the provisions and does not supersede the individual provisions of our group insurance contracts, benefit plans, and university policies that it describes. Similarly, the information presented does not guarantee that the university, the state of Ohio, and/or others responsible for these contracts, plans, programs, and policies will not make future changes in the provisions applicable to each.