Your HDHP Preventive Silver Plan

Congratulations on enrolling in our HDHP Preventive Silver Marketplace plan!

Now that you have your plan, start right by making an appointment with your in-network family doctor and/or cardiologist. If you don’t have a provider that is in-network, use our Find a Doctor tool to find one now.

  1. Take the brochure that you got in your welcome kit with you. If you don’t have it, you can view or download it Navigate here.
  2. As a Preventive Silver plan member, you may get many drugs, services, and supplies* at $0 cost to you!
    • If you need any of the $0 cost tests* available, such as a cholesterol (LDL) or A1C test, get them.
    • If you are on any of these $0 cost drugs*, such as atorvastatin or Jardiance* and if they are appropriate for your condition, ask your provider for a new prescription.
    • If you need a glucose meter* and supplies, or similar $0 cost self-management tools*, ask your provider to write a prescription for them and take it to your in-network pharmacy.
  3. Sign-up for home delivery of your maintenance medications. It is a convenient way to have a 90-day supply of medicines delivered right to your door! Ask your provider to ‘e-prescribe’ a 3-month supply to Express Scripts. Your provider should already have the website and phone number.

Plan Costs

Learn more about your plan’s costs by reviewing your Schedule of Benefits.

Your Health is Important

Remember, this is a plan that is focused on prevention rather than treatment. Although you are covered for treatment of any sickness or disease, just as you are with any CareSource Marketplace plan, your greatest savings will be found with preventive care. Your $0 cost drugs and tests cover preventive treatment and care for both diabetes and heart conditions. If your doctor has prescribed a listed drug for treatment purposes (and not preventive purposes) then your plan does not provide coverage for that drug before your deductible is satisfied.

Learn more about diabetes, heart disease and how to treat them by visiting the Diabetes or Heart Disease Health Center. Find out about diagnostic tests, how heart disease affects men and women differently, and how to manage it. Learn about the endocrine system and the difference between type 1 and 2 diabetes. Learn some of the complications to watch for. Use tools and multimedia to take quizzes and assessments, watch videos and more!

Visit our Interactive Health Library, then choose Health Centers from the top menu, then Heart Disease to learn more about heart conditions and diseases and how to treat them, or Diabetes to learn more about diabetes and how to treat it.

The library is powered by WebMD® and is updated continuously with the latest information.

Need More Information?

Call Member Services for help with your plan or finding an in-network provider or pharmacy.

* Your coverage includes a preventive drug benefit. This means that preventive drugs (medications to help prevent chronic conditions and illnesses) are covered outside of your plan’s deductible. These drugs can, at times be prescribed for treatment purposes. As a result, the listing of a drug does not mean that it will be covered by your benefit plan before your HDHP deductible is satisfied. If your doctor has prescribed a listed drug for treatment purposes (and not preventive purposes) then your plan does not provide coverage for that drug before your HDHP deductible is satisfied. Please be reminded that Health Savings Accounts (HSAs) have tax and legal ramifications^. CareSource cannot guarantee or provide any legal advice on the way these products are prescribed for preventive purposes or that the IRS would agree that all satisfy the definition under §223 NOTICE 2019-45.

As everyone’s medical circumstances are different, and because proper classification is necessary for you to ensure you are complying with applicable HDHP tax regulations, it is important for you to confirm the purpose of the prescription with your doctor. Please call the number on your member ID card when your doctor confirms for you that they prescribed one of the listed drugs for treatment purposes so your claims can be processed correctly. Unless you provide us with this information, claims for the drugs listed in the will be processed as “preventive,” and you or your doctor may be asked by us to provide medical records showing that the drug you’re taking is being used for prevention. Remember, if you improperly classify the drug, it may result in adverse tax consequences so please be sure to take the confirming step to properly classify your claim.

Please follow these steps to make sure you are properly classifying the purpose of your prescription:

Find your drug on the list.

  1. Talk to your doctor about whether your drug is in fact being prescribed for preventive purpose (and not treatment purposes).
  2. If prescribed for treatment purposes, call the number on your member ID card to let us know.
  3. If prescribed for preventive purposes, there is no need to call.

^Consult your financial professional. This is not financial advice.