Stark County Schools COG Newsletter

Online

1. Visit www.caremark.com to register as a user (any family member 18 or older will have to register individually)
2. Set up method of payment
3. Order prescription refills
4. Check order status
5. View prescription history
6. Verify drug coverage
7. View list of Caremark participating pharmacies
8. Access trusted healthcare web sites and healthcare information
9. Obtain detailed drug information

Local, Retail Pharmacy

1. For immediate medicine needs or short-term medications
2. Prescriptions for controlled substances and dermatologic medications
3. For new prescriptions that will be long term medications, you will be able to fill that prescription two times at your local, retail pharmacy before being required to use mail order.
4. Local, retail pharmacies that are available to you can be found on the caremark.com website. You can look there to verify if a pharmacy is in-network. The only local, retail pharmacy that is definitely not in-network is Walgreens. NO WALGREENS.

Mail Service Pharmacy

1. Mandatory for maintenance or long-term medicines
2. To get started with mail order, have physician either call (800-378-597) or fax (800-378-0323). Once your physician has sent the prescription to Caremark and you have set up a payment method, the medication will be sent to you.  
3. If your physician writes you a prescription instead of sending it in for you, please send the prescription to Caremark with the Mail Service Order Form that is available on the caremark.com website. Go under Plans & Benefits, Print Plan Forms, Mail Service Order Form.

Cost of Prescriptions

Generics 20% Coinsurance
Preferred Brands 20% Coinsurance 
Non-Preferred Brands 30% Coinsurance 

1. Mail order prescriptions will be delivered in 3-month supplies. Member will pay 20% or 30% of the cost of the medication.
2. Retail, local pharmacy will be refilled one-month at a time. Member will pay 20% or 30% of the cost of the medication.

Generic Medications

1. Generic Medications are required when a generic is available unless the provider proves medical necessary for a brand name or non-preferred generic medication.  Without proof of medical necessity for a brand or non-preferred medication, the member will pay 100% of the cost of the medication. Provider can send letters of medical necessity for a brand or non-preferred medication.

Specialty Medications

1. Specialty medications will need a Prior Authorization (PA). Your doctor will need to send the PA to Caremark Specialty Pharmacy to get it approved.
2. Once approved, all specialty medication prescriptions will need to be purchased through the Caremark Specialty Pharmacy. A 30-day supply will be mailed to your home.
3. If on a specialty medication, you need to sign up for PrudentRx through Caremark. This will allow you to get your medication at no cost if the medication is on the list of preferred specialty medications.
4. If your specialty medication is not on PrudentRx’s preferred list, your cost will be 30% up to your annual max of $1,050/person. Once the max is met, your medication will be at no cost for the remainder of the calendar year.

Prescription Card

1. You will not receive a separate prescription card. The medical card is also your prescription card. There is information for the pharmacist printed on the medical card.  Please present this card to the pharmacist when picking up prescriptions. You also use the ID number (or social security number) on your medical card as your ID number with Caremark when registering as a user and ordering prescriptions through mail order.  

What is PlanSource?

PlanSource an online platform for managing benefits offered through your employer such as medical, dental, vision, FSA (medical and dependent care reimbursement accounts), and life insurance. This is where you will be required to complete your New Hire Enrollment, Life Events and Annual Open Enrollment for next year’s coverages.

Life Events are:

• Adoption, birth, gain custody of a dependent
• Marriage
• Divorce
• Adding coverage to Employee or dependent due to loss of other coverage 
• Removing coverage to Employee or dependent due to other coverage or when your dependent child turns 26 years old 

Open enrollment season begins soon! Be sure that you re-enroll in your benefits during your employer’s open enrollment period, so you are eligible for coverage period beginning 1/1/2026. Your employer will provide you with the needed information to gain access to the online portal if you do not already have access.*

If you are declining coverage, you are still required to log into PlanSource and decline your coverage.

Watch a 6-minute video which further explains PlanSource and how to enroll in your benefits below. 

*If your employer is currently in the on-boarding stages of PlanSource and you do not yet have access to PlanSource, you are not mandated to re-enroll in your health benefits. Your benefits will automatically roll over for the 1/1/2026 coverage period. Please check with your employer if unsure.

• Open Enrollment begins on November 1, 2025, through November 30, 2025, or as defined by your benefits team.
• To continue or enroll in coverage, log into PlanSource and select your benefits related to Medical, Dental, Vision, Life and Flexible Spending Account (FSA).
• Review and update your Life Insurance beneficiary information.
• To decline or waive coverage, log into PlanSource and decline your benefits related to Medical, Dental, Vision, Life and Flexible Spending Account (FSA).
• For groups not yet set-up with PlanSource, please follow instructions from your benefits team.
• For important information regarding the Spousal Carve out rules, refer to the Spousal Carve Out article in this newsletter.
• Health Plan Benefits remain the same as 1/1/2025:
  • Single: Deductible $350, Coinsurance $1,050, Maximum Out-of-Pocket $1,400
  • Family: Deductible $700, Coinsurance $2,100 Maximum Out-of-Pocket $2,800
  • Refer to the Medical Mutual or AultCare Benefit Highlight Sheets
• Flexible Spending Account (FSA) - Contribution Limits:
  2026 Projected Limits include
  • Medical: $3,400
  • Dependent Care: $7,500 
  • Medical FSA carryover limit: $680
  • No carryover for dependent care contributions
• New ID Cards will not be distributed for 01/01/2026, unless members make benefit changes.

AultCare and Medical Mutual offer robust diabetic preventive and monitoring programs which include free home delivery of diabetic supplies for eligible members enrolled in their respective program. Click on the links below to find out if you are eligible, and how to enroll. 

AultCare Diabetes Telemonitoring Program

The AultCare Health and Wellness program provides a Diabetes Telemonitoring Program at no additional cost for members diagnosed with diabetes. Key features include:

• Home Monitoring Equipment and Free Supplies: Members receive telemonitoring equipment and diabetic supplies to track blood glucose levels from home.
• Registered Nurse Support: A nurse monitors your results, identifies trends, and provides personalized coaching and support.
• Educational Materials: Resources are provided to help members understand and manage their condition.
• Data Sharing: Results can be shared with your physician for better care coordination. 

Medical Mutual Diabetes Programs 

Medical Mutual partners with the Lark Diabetes Care Program to offer a digital diabetes management program at no cost to members. Features include:

• Free Supplies: A complimentary smart scale and glucometer with testing supplies.
• 24/7 Digital Coaching: Personalized support via smartphone or tablet.
• Educational Lessons: Covering nutrition, activity, stress, and sleep.
• Real-Time Tracking: Through the Lark app for glucose, food, and activity.

The Working Spouse Coverage Rule is one of our most asked about policies. To help clear up any confusion, we’ve created this comprehensive Frequently Asked Questions sheet  to answer your most pressing questions and provide guidance for navigating this rule.