IMRF Endorsed Plans

Prescription Drug Plans

Blue Cross and Blue Shield Medicare Part D

• Available to retirees residing in Illinois
• The stand alone plans listed below are independent of medical coverage plans

	Value Plan	Plus Plan	Standard Plan
Deductible	$0.00	$0.00	$310.00
Generic co-pay	$11.00	$5.00	$3.00
Preferred brand co-pay	$45.00	$38.00	$27.00
Non-preferred co-pay	$89.00	$75.00	$78.00
Specialty drug co-pay	30%	33%	25%
Mail order (3 month supply) * Generic * Preferred Brand * Non - Preferred	$27.50 $112.50 $222.50	$12.50 $67.50 $195.00	$7.50 $95.00 $187.50
Monthly premium	$28.30	$78.50	$46.50

• Fees listed above apply until you reach $2,830.00 in annual drug costs. After annual drug costs exceed $2,830.00, the Value and Standard plans require you to pay 100% of drug costs until your out-of-pocket costs exceed $4,550.00. The Plus Plan requires a $5.00 co-pay for generics, $12.50 for a three month supply of generics at select pharmacies, and 100% of any other drugs during this time. Once your out-of-pocket drug costs exceed $4,350.00 for all three plans you pay the greater of a $2.50 co-payment for generic ($6.30 for preferred brand or brand name) or 5% coinsurance.
  

65 and Over Plans Blue Cross and Blue Shield of Illinois Plan F Humana Private Fee for Service Plan Health Alliance HMO Health Alliance PPO United Healthcare Missouri Mercy Health Plan Premier Plus Blue Cross and Blue Shield of Texas Plans Humana Regional PPO Seniors Choice (Group Retiree Program) Prescription Drug Plans Blue Cross and Blue Shield Medicare Part D Humana Medicare Part D Plans Humana Group Prescription Drug Plan Sav-Rx Plan Sav-Rx Enrollment Form Delta Dental About Delta Plan Delta Dental Enrollment Form Under 65 Plans Blue Cross and Blue Shield of Illinois - Under 65 Plan Request Personalized Quote Long Term Care About the Plan United Healthcare Vision Plan About the Plan