FAQs

A:  All GLP-1 are a Tier 2 Preferred Brand Copay of $40.

A: The answer yes, IF, the hospital is a contracted (Blue Cross) hospital. All in-network copays and deductibles apply towards the annual Out of Pocket Maximum. 

To meet the individual deductible in a plan year a member must meet the 50 copay cap ($35 x 50 = $1,750) as well as the Individual Deductible ($350).

A:   Examples of Office Visits to Specialty providers would include, but are not limited to:  Orthopedists, Gastroenterologists, Cardiologists, Endocrinologists, Neurologists, Oncologists, Urologists, Rheumatologists, Pulmonologists.

A:  Only Inpatient and Outpatient Hospital charges and charges from ambulatory surgical centers apply towards the annual deductible. Currently the annual Individual deductible is $350 and the annual Family deductible is $700 so only 2 members of a family need to meet their Individual to satisfy the Family deductible. Once the Family deductible is met, no other family members will have to satisfy a deductible for the rest of the plan year. The plan year runs from 9/1 – 8/31.

A:  No. As of 9/1/2026 – The plan no longer will cover GLP-1 medications for weight loss only. GLP-1 medications will remain available for members with a diagnosis of Diabetes. The district has implemented the Rx Savings Plus program through CVS, at no cost to the plan, which will provide significant savings on GLP-1 medications for members who have met their $5,000 Liftetime Maxiumum. Click here for more information Rx Savings Plus

A: With the Tier 3 Deducible option the member would need to satisfy a $350 deductible once per plan year before the plan would start paying for brand name prescriptions. Due to the high cost of brand name prescriptions this would most likely happen on the first brand name prescription filled in a plan year. Once the deductible is met, the member would then only pay the $50 copay for all remaining 30 day supplies of a brand name prescription for the rest of that plan year.  For example:

Member fills first brand name prescription in a plan year which costs $3,000:

• Member first pays the $350 Tier 3 Deductible as well as the $50 copay and the plan pays the remaining $2,650. 
• The Tier 3 Deductible is now met and the plan will pay 100% of the cost of all subsequent brand name fills after the member pays the $50 copay for the rest of the plan year. 
• The Plan year begins on 9/1 and ends on 8/31.

A:  An out of pocket maximum (OOPM) is the most you will pay during a plan year for in-network covered services. In-network copays and deductibles apply toward the OOPMs.

CUSD’s current 26/27 Plan Year OOPMs are as follows:

$2,100 - Individual

$4,200 – Family

To meet the individual deductible in a plan year a member must meet the 50 copay cap ($35 x 50 = $1,750) as well as the Individual Deductible ($350).

To meet the family OOPM 2 people in a family need to meet the Individual OOPM. Once the Family OOPM is met, no other family members have out of pocket expenses (copays or deductibles) for the rest of that plan year.

A: If admitted to the hospital, the emergency room copay ($250) will be waived and/or applied to the deductible.