Page 3 - CPC-Preventive-Care-Guide-2013

S m a r t e r .

H e a l t h i e r .

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L OW E R C O PAY S F O R C E R TA I N

P R E V E N T I V E D R U G S

Preventive drug therapy is an important component of

effective preventive care. Preventive drugs are those

medications used for the prevention of certain health

conditions such as high blood pressure, high cholesterol,

diabetes, asthma, osteoporosis, heart attack and stroke.

All three medical plan options (Select EPO, Choice PPO

and Value CDH Plans) feature lower copays for designated

preventive drugs. When these drugs are prescribed for

listed conditions, you’ll pay only $10 for a 30-day retail

supply, or $20 for a 90-day mail-order supply.

All

deductibles are also waived for these selected drugs.

These conditions are being targeted because their

effective, early management can help prevent future

serious complications and reduce future medical costs.

Some of the conditions and drugs on the preventive

drug list for Chevron Phillips Chemical Company are:

Finding PPO and Preventive Dental Providers

•

For cardiovascular conditions — drugs such as lisinopril,

atenolol, aspirin, amlodipine besylate

•

For high cholesterol — drugs such as simvastatin

•

For diabetes — insulin, drugs such as glyburide and

metformin HCL, supplies such as meters and One Touch

strips

•

For asthma — designated inhalers

This is not a complete list. The complete list can be found

at

www.mycpchembenefits.com.

In addition, a few select preventive drugs are covered at

100% — when prescribed by a physician — with no

deductible, copay or co-insurance, as follows:

•

For iron deficiency in children — iron supplements

•

For pregnancy — folic acid supplements

•

For birth control — designated contraceptives (and

contraceptive counseling)

•

As prescribed to prevent cardiovascular disease — aspirin

•

For children aged 6 months through 5 years — oral

fluoride supplements

Dental

Practicing good oral hygiene through daily brushing and flossing is important to your overall health. Periodontal disease,

when unchecked, can allow harmful bacteria to enter your bloodstream, which can lead to serious health issues, such

as diabetes, heart disease, stroke and complications with pregnancy.

C OV E R E D S E R V I C E S

Chevron Phillips Chemical’s dental coverage provides a range of preventive care services, covered at 100% with no

deductible. Claim payments to participating dentists are based on a negotiated schedule of discounted fees. Claim

payments to non-participating dentists are based on reasonable and customary (R&C) fees.

Covered Service

Comprehensive Dental Plan Preventive Dental Plan

•

Oral exams, limited to two per year

100%

•

X-rays, full mouth (including bitewing, if necessary), limited to one set every three years

100%

•

X-rays, bitewing only, limited to two sets per year

100%

•

Prophylaxis (cleaning, scaling and polishing) limited to two per year

100%

•

Fluoride treatments, for children to age 17, limited to two per year

100%

•

Sealants for children to age 15, one application every three years, permanent molars only 100%

100%

•

Space maintainers for children to age 17, unilateral or bilateral, fixed or removable,

including adjustments within six months of installation

100%