Medical and Rx
Medical
Montefiore offers two Medical options from which you can choose – MonteCare EPO and MonteCare PPO – or you can waive coverage.
Provider Networks
MonteCare EPO and MonteCare PPO both use the Anthem Network (Preferred and Non-preferred Facilities) and Montefiore Network:
- MonteCare EPO requires you to use in-network providers to receive benefits. Your share of the cost will be higher when you use Anthem Network Non-preferred Facilities.
- MonteCare PPO gives you the flexibility to choose any provider you wish (however, you’ll pay more for healthcare services from Network Non-preferred Facilities).
Care Guidance
The Care Guidance Program for Montefiore associates provides you with a Personal Health Nurse (PHN) who will work one-on-one with you for as long and as often as you need. This is a voluntary program that can provide support and resources to help you, or a member of your family, manage your or their health. Montefiore provides this program at no cost to Montefiore associates and their family members who are covered by Montefiore’s Anthem BlueCross BlueShield medical plans. All services are completely confidential and at any point in time, you have the opportunity to OPT OUT of the program. For more information, call 855.MMC.WELL (855.662.9355) or email mmccareguidance@montefiore.org.
Prescription Drug Benefits
Prescription drug benefits are included in your medical coverage.
Prescription Drug Out-of-Pocket Maximum
Your share of expenses for prescriptions obtained from Montefiore outpatient pharmacies, Express Scripts participating retail pharmacies, home delivery pharmacy service or out-of network pharmacies is limited to $1,500 for any one covered person ($3,000 for a family) in a calendar year. Once that maximum is reached, the Plan pays 100% of any remaining prescription drug expenses for that individual for the rest of the calendar year. If you purchase a brand name medication (preferred and non-preferred) when a generic equivalent is available, you are responsible for the retail or mail order generic copayment plus the difference in cost between the generic and the brand name medication. The difference in cost between the generic and the brand name medications is not included in the out-of-pocket maximum and is not eligible for 100% reimbursement after the out-of-pocket maximum has been met.
New Pharmacy Benefit Management Program
Effective February 1, 2025, a new pharmacy benefit management program will be introduced specifically for a class of drugs used to treat Type 2 diabetes and obesity (called GLP - 1 drugs). This new feature will help ensure improved outcomes for those patients who require these drugs.
New Hire, New to Benefits or looking for current year benefit information?
Find Benefits Summaries, Medical Comparisons and More
Visit the New Hire or New To Benefits page to access information about your benefits offerings for 2025.
Annual Open Enrollment
is Coming in November!
Check back soon for important information about Annual Open Enrollment, including exciting changes coming to your benefits enrollment experience.
