2026 AtlantiCare Benefits Booklet

PRESCRIPTIONDRUGCOVERAGE

WELCOME....................................2 WHAT’S NEW..............................3 HOW TO ENROLL......................4 HEALTHCARE TRANSFORMATION CONSORTIUM (HTC)...............6 GETTING TO KNOW YOUR PLAN.................................7 MEDICAL......................................8 PRESCRIPTION DRUG.......... 17 FQHC........................................... 19 ADDITIONAL MEDICAL PLAN RESOURCES................. 20 WELLNESS PROGRAM......... 21 DENTAL...................................... 23 VISION........................................ 25 LIFE INSURANCE.................... 28 DISABILITY............................... 30 VOLUNTARY OFFERINGS... 31 EDUCATIONAL SUPPORT & CAREER DEVELOPMENT...................... 31 FINANCIAL WELL-BEING.... 32 HEALTH &WELLNESS.......... 33 SAVINGS.................................... 34 VOLUNTARY BENEFITS....... 35 SPENDING ACCOUNTS............................... 38 RETIREMENT BENEFITS................................... 39 CONTACTS................................ 41 LEGAL NOTICES....................... 43 WELLNESS CHECKLIST........ 45

Always consider using the AtlantiCare Pharmacy first, because it typically provides the least out-of-pocket cost. AtlantiCare Pharmacy (Retail and Mail Order) The AtlantiCare Pharmacy ofers AtlantiCare employees and their covered dependents the opportunity to fill prescriptions at a reduced cost. Medications can be filled for as little as $10 (generic) or $20 (brand name preferred) for a 30-day supply. Medication copay costs will double for a 90-day supply. There are three AtlantiCare Pharmacy locations: Atlantic City

• Regardless of which medical plan option you choose, you automatically receive prescription drug coverage through MedImpact. • You do not need to enroll separately in the prescription plan. Prescription coverage is included as part of the Medical plan enrollment. Your prescription plan information can be found on your prescription ID card. • Should you need a replacement ID card, please call MedImpact Customer Service at 1-833-229-3595 . • Refer to the table below for the copay amounts you will pay under the Prescription Drug plan. • The maximum amount that you will pay for prescriptions per year: Single $1,750/Family $3,500.

AtlantiCare HealthPlex, 1401 Atlantic Ave. Tel: 1-609-441-7088 Fax: 1-609-441-7089 Hours of Operation: Monday through Friday, 8:00 am to 6:00 pm Galloway* 54West Jimmie Leeds Road Tel: 1-609-404-7444 Fax: 1-609-404-7445 Hours of Operation: Monday through Friday, 8:00 am to 6:00 pm Saturday, 9:00 am to 4:00 pm Manahawkin 517 Route 72W Tel: 1-609-704-6800 Fax: 1-609-704-6801 Hours of Operation: Monday through Friday, 9:00 am to 5:00 pm

Non-Specialty Medications AtlantiCare Pharmacy (Retail &Mail Order) Generic Brand Preferred Brand Non-Preferred

Copays for 30/90-day supply $10/$20 $20/$40 $50/$100

Non-AtlantiCare Retail Pharmacy Generic Brand Preferred Brand Non-Preferred

Copays for 30- day supply

Minimum $15 $50 N/A

15% 30% 100%

Specialty Medications AtlantiCare Retail Pharmacy Generic Brand Preferred Brand Non-Preferred *Other Specialty Pharmacy Generic Brand Preferred Brand Non-Preferred

Copays (up to 30-day supply) $10 $20 $50

In the case of an emergency, you may use the AtlantiCare Community Pharmacy located inside the ARMC City and Mainland campuses. Hours of operation are Monday through Friday, 8:00 am to 8:00 pm, and Saturday and Sunday, 9:00 am to 6:00 pm. Please note, you may utilize these pharmacies for emergencies only. They do not carry enough supply for employees’ daily usage. *AtlantiCare pharmacy offers mail order service for all active employees and their dependents at no additional cost. Medications are delivered within 2-3 days. Please call the Galloway Pharmacy at 1-609-404-7444 to arrange for your medications to be shipped to your home.

Copays (up to 30-day supply)

Maximum $150 $150 $150

10% 20% 30%

*If the AtlantiCare Pharmacy is unable to fill your request, they will direct you to contact MedImpact Customer Service for assistance in obtaining your medication

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