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Wellness benefit of $250 per participant: The Wellness Benefit is av ilable to each participating <br /> member of the family and can be used for annual physicals, well baby care checkups, and school <br /> physicals. Immunizations (such as flu shots and immunizations for babie ) are not eligible expenses <br /> under this benefit. There is no deductible or co-pay for the VVellness Benefit. <br /> Health credits: Each year, each covered person can earn up to four hea h credits toward the annual <br /> deductible by: (1) Abstaining from tobacco products; (2) having blood pre�sure in the American Heart <br /> Association recommended acceptable range; (3) keeping cholesterol in the American Heart Association <br /> recommended acceptable range; and (4) having heighUweight ratio appro riate for age, sex and body <br /> frame. To receive credit(s), the plan participanYs physician must certify th t criteria have been met. A <br /> separate certificate must be submitted to the plan administrator for each fami y member seeking credit(s). <br /> Disease management program: Participants with specific diseases will e provided information and <br /> suggestions to help them become better managers of their medical situation . <br /> 3-tier drug program: The Express Scripts Formulary/preferred drug list II be used to determine the <br /> level of prescription drug benefit. Participant co-pay per prescription will be: <br /> 1. GENERIC (medications approved by USFDA that are as safe and e ective as brand-name drugs, <br /> but that cost less): $10 <br /> . F R R P ri � n n h f rmula list : 20 <br /> 2 ORMULA Y O REFERRED brand-name resc tio s o t e $ <br /> � p P rY ) <br /> 3. NON-FORMULARY(brand-name prescriptions not on the formulary ist): $50. <br /> Co-pays will not apply to annual out-of-pocket maximums. There is no coor ination of benefits with other <br /> insurance companies for the 3-tier drug program. To access the on-line formulary list, register at <br /> www.express-scripts.com. <br /> Dual family coverage: Only one spouse is permitted to carry family cove age when both work for the <br /> City. The birthday rule is used to determine which spouse carries the c verage. Both spouses are <br /> permitted to carry single coverage, if they prefer. <br /> Enrollment changes: Changes in enrollment, except for COBRA qualifying vents, will only be permitted <br /> on a two (2) year cycle, at renewal time. <br /> 42 <br />