TRIP Prescription Plan

Plan participants enrolled in any TRIP health plan have prescription drug benefits included in the coverage. All prescription medications are compiled on a preferred drug list ("formulary list") maintained by each health plan's prescription benefit manager (PBM). Formulary lists categorize drugs in four levels: Reduced Tier 1, Tier1, Tier 2 and Tier 3 brands. Each level has a different copayment and/or coinsurance amount.

Participants enrolled in the Teachers' Choice Health Plan (TCHP) pay 20% of the retail cost of prescriptions, not to exceed a set maximum or be less than the set minimum copayment amount.  Additionally, TCHP plan participants have a $1,500 annual prescription out-of-pocket maximum.  Once this out-of-pocket maximum has been met, prescriptions obtained for the remainder of the plan year will be covered at 100%. 

Coverage for specific drugs may vary depending upon the health plan. It is important to note that formulary lists are subject to change any time during the plan year. To compare formulary lists, cost-savings programs and to obtain a list of pharmacies that participate in the various health plan networks, plan participants should visit the website of each health plan they are considering. Plan participants who have additional prescription drug coverage, including Medicare, should contact their plan’s PBM for coordination of benefits (COB) information.

Plan participants who have additional prescription drug coverage, including Medicare, should contact their plan’s PBM for coordination of benefits (COB) information.

Plan participants enrolled in HealthLink OAP, Aetna OAP, BlueCross BlueShield of IL OAP, or the Teachers' Choice Health Plan (TCHP), have CVS/caremark as their PBM.

Under the Affordable Care Act, Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs, will be covered by the plan without cost-sharing requirements.

• No Cost Preventive Services & Contraceptives

 * Using out-of-network services may significantly increase your out-of-pocket expense. Amounts over the plan’s allowable charges do not count toward your plan year out-of-pocket maximum; this varies by plan and geographic region.

** Medications received at CVS Caremark® Pharmacy or through CVS Caremark® Mail Service Pharmacy. Deductibles apply.

Prescription Vacation Override Process (For the Self-Insured Plans only)

Teachers’ Retirement Insurance Program (TRIP) retirees and their covered dependents that are actively enrolled in one of the TRIP OAP health plans or the TCHP health plan are eligible for 2 Prescription Vacation Overrides per year.

Employees and/or their covered dependents going on vacation or an extended stay outside of the United States, who require an early refill or who will need medications to cover a period greater than the current prescription refill, must request an exception for a Prescription Vacation Override for that time period. This form Prescription Vacation Override Request needs to be filled out in its entirety and sent to the email/physical address at the bottom of the form.

Note: If you are enrolled in a TRIP - HMO health plan you will need to contact your health insurance carrier to obtain information on their process for this type of request.

MAPD MEMBERS – Need to contact Aetna directly to obtain their process for this type of request.