Prescription Claim Costs

Student Health Insurance 2017 - 2018 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 or co-insurance to access the discount prescription drug benefit. 

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 DEDUCTIBLE, CO-PAYMENTS, and CO-INSURANCE

After a separate $150 Prescription Plan Year Deductible, a $15 Co-payment applies to Tier 1 medications and 20% Co-insurance applies to Tier 2 and 3 medications.  Tier assignments are subject to change for any given prescription drug as bulk discounts change.  To determine the payment, call the pharmacy network at 1-855-828-7716.

PRESCRIPTION PRE-AUTHORIZATION

A few high dollar prescriptions require pre-authorization before purchasing the medication, generally those purchased from a Specialty Pharmacy.  Call the pharmacy network at 1-855-828-7716 to determine if your medication requires pre-authorization or refer to the UHC prescription drug list.

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.