Prescription Claim Costs

Student Health Insurance 2016 - 2017 Plan Year

REFILLS DURING OPEN ENROLLMENT

To have continual access to prescriptions, you must have prescription refills available and you must accept the Premier Plan at least 15 days before the effective date of the new Plan Year.

SUBSCRIBER NUMBER

Your nine digit GUID/GoCard number beginning with an "8" is your Premier Plan health insurance subscriber number.

ACCESSING PHARMACY DISCOUNTS WITH YOUR ID CARD

Present your ID card at United HealthCare Network Pharmacies and pay only the co-payment to access the discount prescription drug benefit. 

After Open Enrollment, if instead of using your pharmacy card to purchase a prescription, you pay for the prescription drugs in full at the retail price and submit a prescription claim form; the plan will apply the Co-payment and reimburse you at the discount price, not the retail price. You will be responsible for prescription drug payments in excess of the discounted price.

PRESCRIPTION CO-PAYMENTS

Co-payments are $15, $40, or $70. Co-payments are subject to change for any given prescription drug as bulk discounts change. Generic prescription drugs have a $15 co-payment applied. To determine the co-payment, call the pharmacy network at 1-855-828-7716.

CONTRACEPTIVE COVERAGE

Medications to prevent pregnancy are not covered under the Premier Plan unless required to treat an illness. Because Federal regulations require plans to cover birth control, UnitedHealthcare will Accommodate Georgetown University's religious objection and pay for birth control without cost to the Premier Plan. Present your UnitedHealthcare/Premier Plan ID card with your prescription to an network pharmacist to obtain your medication with no out-of-pocket expense.

PRESCRIPTION EXTENSION REQUEST FORM

To request an extension of prescription coverage beyond an authorized 30 day supply due to traveling outside of the United States, download a Prescription (RX) Extension Request Form from the Arthur J. Gallagher & Co., Student Health & Special Risk Web site.