Choice Share

Annual Deductible: Individual $0 / Family $0

What you pay for care received

• Doctor office visits: 20% coinsurance after deductible per visit for PCP / 20% coinsurance after deductible per visit for Specialist
• Hospital Stay: $600 copay/day first 6 days per stay
• Emergency Room: 20% coinsurance after deductible
• Urgent Care: 20% coinsurance after deductible

Prescription Drugs
Retail 30 day supply / Retail or Mail order 30-90 day supply

• Generic: $15 / $30 (90 day supply)
• Preferred Brand: $60 / $120 (90 day supply)
• Non-Preferred Brand: $90 / $180 (90 day supply) (copay after deductible)
• Specialty: 30% coinsurance / $0 if enrolled in Prudent RX (30 days only)
• Pharmacy deductible: Individual $250 / Family $500 only for Non-Preferred Brand and Specialty

Pinellas has implemented PrudentRX effective 1/1/2022. Specialty drugs are the most expensive, high-technology and self-administered injectable medications not available on other levels. May be eligible for $0 co-pay under PrudentRx program. If not enrolled, 30% coinsurance applies.

Questions?
Visit pcsb.org/pharmacy for a list of covered medications and additional details on the PrudentRx program. Or call PrudentRx, 1-800-578-4403, Monday through Friday, 8 AM to 8 PM ET.

Look up your prescriptions for the Aetna Standard Plan formulary (PDF) »
Learn more about the Maintenance Choice Program here (PDF) »

Annual Medical out-of-pocket max (does not include prescription copays)

• Individual: $5,000
• Family: $10,000

Annual Pharmacy out-of-pocket max (does not include medical copays)

• Individual: $2,000
• Family: $4,000

Preventive care: Covered 100% (for specific services, frequency limitations may apply)

CVS Virtual Care

• General Medical: $25 per visit / treatment for flu, allergies, bronchitis, and more
• Mental Health: Support for stress, anxiety, depression, and more
• Appointments available by video only to members and eligible dependents 18 and older
• Therapist, Psychologist 20% coinsurance after deductible / session
• Psychiatrist 20% coinsurance after deductible / evaluation
• (Ongoing sessions) 20% coinsurance after deductible / session

CVS Virtual Primary Care (Primary care services for adults ages 18 and up)

Get treatment for:

• Chronic illnesses (asthma, diabetes)
• Sick care
• Wellness and annual health assessment
• Follow-ups from in-person visits
• Medication adjustments and refills
• Some visits starting at zero dollars*
• Get coordination of in-person care, when needed, at nearby MinuteClinic® locations** or in-network provider clinics

*FOR $0 IN-PERSON CARE: Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive services at no cost-share.
**FOR CARE AT MINUTECLINIC LOCATIONS: MinuteClinic® in-person services are not included with this product and are subject to plan benefit. For a list of participating walk-in clinics, use our online provider search tool. Includes select MinuteClinic services. Not all MinuteClinic services are covered or may be covered at negotiated contract rates. Not available in all states. Walk-in appointments aren’t guaranteed. Online scheduling recommended. Check your plan documents for more detail. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered primary care or non-preventive services at no cost-share. Subject to change.