Medical & Rx
We offer you a comprehensive benefits program to help you and your family protect your health and financial security. Your benefits are a valuable part of your compensation; we encourage you to learn how your plans work so you can get the most from them.
You have three (3) plan options through Blue Cross Blue Shield of Rhode Island (BCBSRI).
Medical Plan Design
This is not a complete list of covered services. For more details, please refer to the plan documents.
RISD offers three medical plan options administered by Blue Cross Blue Shield of Rhode Island (BCBSRI).
- The Standard PPO Plan (High Premium / Low Deductible)
- The Mid-Tier PPO Plan (Mid Premium / Mid Deductible)
- The High Deductible Health Plan or HDHP (Low Premium / High Deductible) with the Health Savings Account (HSA)
Each plan has a different premium (the amount you pay upfront through payroll deductions) and out-of-pocket costs (the amount you pay for care throughout the year).
Standard Plan
In-Network
Type of Plan
PPO
Calendar Year Deductible2 (Individual / Family)
$250 / $500
Your Coinsurance3
0%
Out-of-Pocket Maximum (Individual / Family)
$3,000 / $6,000
Physician Visit (Primary Care / Specialist)
$15 copay / $25 copay
Preventive Care Services4
Covered 100%
Lab, X-Ray or Other Preventative Tests
0%
Hospital Services
(Inpatient / Outpatient)
0%
Urgent Care Visit
$25 copay
Emergency Room Visit
$100 copay
Out-of-Network
Calendar Year Deductible2 (Individual / Family)
$250 / $500
Your Coinsurance3
20%
Out-of-Pocket Maximum (Individual / Family)
$4,000 / $8,000
Mid-Tier Plan
In-Network
Type of Plan
PPO
Calendar Year Deductible2 (Individual / Family)
$500 / $1,000
Your Coinsurance3
10%
Out-of-Pocket Maximum (Individual / Family)
$3,000 / $9,000
Physician Visit (Primary Care / Specialist)
$25 copay
Preventive Care Services4
Covered 100%
Lab, X-Ray or Other Preventative Tests
0%
Hospital Services
(Inpatient / Outpatient)
10%
Urgent Care Visit
$25 copay
Emergency Room Visit
$100 copay
Out-of-Network
Calendar Year Deductible2 (Individual / Family)
$500 / $1,000
Your Coinsurance3
30%
Out-of-Pocket Maximum (Individual / Family)
$3,000 / $9,000
High Deductible Health Plan
In-Network
Type of Plan
HDHP
Calendar Year Deductible1,2 (Individual / Family)
$1,750 / $3,500
Your Coinsurance3
10%
Out-of-Pocket Maximum (Individual / Family)
$3,300 / $9,000
Physician Visit (Primary Care / Specialist)
10%
Preventive Care Services4
Covered 100%
Lab, X-Ray or Other Preventative Tests
10%
Hospital Services
(Inpatient / Outpatient)
10%
Urgent Care Visit
10%
Emergency Room Visit
10%
Out-of-Network
Calendar Year Deductible1,2 (Individual / Family)
$1,750 / $3,500
Your Coinsurance3
30%
Out-of-Pocket Maximum (Individual / Family)
$3,300 / $9,000
- When enrolling in a High Deductible Health Plan, all covered services are subject to the deductible except Preventive Care services.
- The deductible year runs on the calendar year, January 1 through December 31.
- The amount you pay after the deductible is reached. Your coinsurance kicks in once the calendar year deductible is met.
- Preventive care services include but are not limited to routine wellness exams, pelvic exams, pap testing, PSA tests, and immunizations. Covers preventive care services rendered in a physician's office and outpatient service centers.
Contact the provider of these benefits by calling this phone number or visiting this website: 1 (401) 459-5000, www.myBCBSRI.com
Prescription (Rx) Plan Design
CVS Caremark | For more details, please refer to the plan document.
When you enroll in medical coverage, you will be automatically enrolled in the prescription drug program through CVS Caremark. Medications are grouped into tiers, and the tier that your medication falls into determines your portion of the drug cost.
Please note, when enrolled in the High Deductible Health Plan, you must meet your deductible before the plan begins sharing in the cost of your prescriptions. Additionally, the Standard Plan includes a $100 prescription drug deductible that does not apply to Tier 1, low cost generic drugs.
Standard Plan
RETAIL (30-DAY SUPPLY)
Tier 1 - Low Cost Generic
$7 copay
Tier 2 - High Cost Generic and Preferred Brand
$30 copay after Rx deductible
Tier 3 - Non-Preferred Brand
$50 copay after Rx deductible
Tier 4 - Specialty Brand
Specialty pharmacy: $75 copay after Rx deductible
Retail: 50% after Rx deductible
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Low Cost Generic
$17.50 copay
Tier 2 - High Cost Generic and Preferred Brand
$75 copay after Rx deductible
Tier 3 - Non-Preferred Brand
$125 copay after Rx deductible
Mid-Tier Plan
RETAIL (30-DAY SUPPLY)
Tier 1 - Low Cost Generic
$7 copay
Tier 2 - High Cost Generic and Preferred Brand
$30 copay
Tier 3 - Non-Preferred Brand
$50 copay
Tier 4 - Specialty Brand
Specialty pharmacy: $75 copay
Retail: 50%
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Low Cost Generic
$14 copay
Tier 2 - High Cost Generic and Preferred Brand
$60 copay
Tier 3 - Non-Preferred Brand
$100 copay
High Deductible Health Plan
RETAIL (30-DAY SUPPLY)
Tier 1 - Low Cost Generic
$7 copay after medical deductible
Tier 2 - High Cost Generic and Preferred Brand
$30 copay after medical deductible
Tier 3 - Non-Preferred Brand
$50 copay after medical deductible
Tier 4 - Specialty Brand
Specialty pharmacy: $75 copay after medical deductible
Retail: 50% after medical deductible
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Low Cost Generic
$14 copay after medical deductible
Tier 2 - High Cost Generic and Preferred Brand
$60 copay after medical deductible
Tier 3 - Non-Preferred Brand
$100 copay after medical deductible
- Standard Plan: Full prescription drug deductible ($100) applies, waived for Tier 1
- Mid-Tier Plan: No Deductible
- High Deductible Health Plan: Full medical deductible applies
Specialty Prescription Copay Assistance Program
As part of our prescription drug plan, RISD offers a copay assistance program through PrudentRx. This program reduces costs for you and RISD by leveraging copay assistance dollars provided by drug manufacturers. When you enroll in the program, you and your covered dependents receive low or no-cost specialty medications on the PrudentRx drug list. More information on the PrudentRx Program can be found here and in the following FAQ:
How do I know if my medication is a specialty medication covered by the PrudentRx program?
- PrudentRx will contact you directly and confidentially to confirm your eligibility. You may also call PrudentRx at 1-800-578-4403 with questions about your medications.
How will I save money with PrudentRx?
- When you enroll in the PrudentRx program, your copays for specialty drugs on the PrudentRx drug list will be low or $0.
How does the copay assistance program work?
- If you and/or your dependent are taking a specialty medication eligible for copay assistance, PrudentRx will contact you directly and confidentially. They will assist you in enrolling in new copay card programs, converting your current copay cards, and managing card renewals.
What if there is no copay card for my medication or the drug manufacturer discontinues their copay card?
- If the manufacturer of the drug you are taking does not offer or discontinues a copay card, you will still be eligible for the same low or $0 copay offered by PrudentRx as long as you opt in to the program.
Can I opt out of the PrudentRx program?
- Enrollment with PrudentRx is not mandatory. However, if you opt not to participate, you will pay 30% coinsurance for your eligible specialty medications. You can opt in or out of the program at any time.
How will my deductible be impacted?
- Staff members on the High Deductible Health Plan must satisfy their deductible before the copay assistance becomes effective.
What happens if my specialty medication is not on the PrudentRx drug list?
- Most specialty medications are included on the PrudentRx drug list. Copays for specialty drugs not on the PrudentRx list will be $75.
Contact the provider of these benefits by calling this phone number or visiting this website: 1 (800) 237-2767, www.caremark.com
Contribution Rates
Blue Cross Blue Shield Member Programs
In addition to the benefits covered by your choice of health plan, Blue Cross Blue Shield of Rhode Island offers programming to help you and your family manage your care and enjoy healthy activities.
Telehealth/Virtual Visits
You can consult with a board-certified physician by secure video with Doctors Online, anytime from anywhere.
Access Doctors Online by logging into bcbsri.com/doctorsonline. Create an account by setting up your username and password to see what you’ll pay for virtual visits.
Some of the non-emergency conditions Doctors Online treats include:
- Cough, sore throat, fever
- Flu
- Ear or sinus pain
- Bumps, cuts, scrapes
- Eye swelling, irritation, or pain
- Nausea, vomiting, diarrhea
- Back pain
- Sprains
- Mild asthma
Wellness
The BCBSRI wellness program, Blue365, rewards you for healthy behavior.
Participants have access to wellness tools, resources, and services, including an online assessment and learning community. Members can also access exclusive health and wellness deals from major brands through Blue365, including discounts on:
- Health Products
- Health and Fitness Clubs
- Weight Loss Programs
- Healthy Travel Experiences
- Ongoing Deals and Weekly Specials
Blue365 features ongoing deals as well as weekly specials. You can log into My Health Toolkit®, online or through the mobile app, to see what savings are currently available.
Visit www.blue365deals.com/BCBSRI for more information.
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This Digital Benefits Guide is intended to highlight available benefits and should not be relied upon to fully determine coverage. The benefits plan may not cover all health care expenses. More complete descriptions of benefits and the terms under which they are provided are contained in the Certificate of Coverage that you will receive upon request. If this Digital Benefits Guide conflicts in any way with the policy issued by the employer, the policy shall prevail.