[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288624-105":53,"doc-detail-288624-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","hsa-rx-spd-navitus","HSA RX SPD Navitus","","Booklet explains prescription drug benefits under the University of Rochester Welfare Benefits Plan for Faculty & Staff, effective January 1, 2026, and states it is part of the summary plan description. It directs readers to related Plan documents for medical coverage and the wrap document SPD. It also describes Plan Sponsor claim payment delegation, plan maintenance and amendment rights, termination effects, and provides contact details for customer care and Navitus claims processing.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/hsa-rx-spd-navitus/288624/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/hsa-rx-spd-navitus/288624.png","ImageObject",442,249,{"name":88,"@type":89},"Aria","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-20","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"When do the prescription drug benefits described in the booklet take effect?","Question",{"text":108,"@type":109},"The benefits are effective January 1, 2026.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What document should be referenced for more information about prescription drug benefits and related coverage?",{"text":113,"@type":109},"Use the Summary Plan Description for the University of Rochester Welfare Benefits Plan (the wrap document SPD) for additional details unless this booklet addresses something otherwise.",{"name":115,"@type":106,"acceptedAnswer":116},"What happens to covered person rights if the Plan is terminated?",{"text":117,"@type":109},"Rights of a Covered Person are limited to expenses incurred before the termination date.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},288624,1789633715,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":125,"read_time":140},2336464648322,"https://ap-avatar.wpscdn.com/avatar/2200025388227c56fec?_k=1778556882303663488","Introduction  \nThis booklet explains the prescription drug benefits available to you under the University of Rochester Welfare Benefits Plan (the “Plan”) for Faculty & Staff of the University of Rochester effective as of January 1, 2026. The booklet is intended to be read with, and considered as part of, the Plan. This booklet also forms part of the summary plan description for the Plan. Unless otherwise addressed in this booklet, please refer to the“Summary Plan Description for the University of Rochester Welfare Benefits Plan” (also known as the “wrap document SPD”) for more information regarding your prescription drug benefits. Enrollment in the University of Rochester medical plans comprises medical and prescription drug coverage. To view summary plan descriptions for medical coverage and the wrap document SPD, please visit [https://www.rochester.edu/human](https://www.rochester.edu/human)resources/benefits/legal-notices/ .  \nThe Plan Sponsor delegates its responsibility with respect to the payment of claims to the Claims Administrator.  \nThe Plan Sponsor fully intends to maintain the Plan indefinitely. However, it reserves the right to terminate, suspend, discontinue or amend the Plan at any time and for any reason.  \nIf the Plan is terminated, the rights of a Covered Person are limited to expenses incurred before the termination date. All amendments to the Plan shall become effective as of the date established by the Plan Sponsor.  \n| Contact Information |  |\n| --- | --- |\n| Customer Care | 833-210-5965 711 (TTY)\u003Cbr>24 hours a day, 7 days a week |\n| Prescription Claims | Navitus Health Solutions\u003Cbr>Attn: Claims Department\u003Cbr>PO Box 999\u003Cbr>Appleton, WI 54912-0999\u003Cbr>Fax: 855-668-8550 (toll-free) |\n| Navitus Website | [Navitus.com/members](Navitus.com/members) |\n| Member Portal | [Memberportal.navitus.com](Memberportal.navitus.com) |\n| Mail Order | Costco Mail Order\u003Cbr>800-607-6861\u003Cbr>[Pharmacy.costco.com](Pharmacy.costco.com) |\n| Specialty Pharmacy | UR Specialty Pharmacy\u003Cbr>855-340-4767\u003Cbr>[Urmc.rochester.edu/pharmacy](Urmc.rochester.edu/pharmacy)\u003Cbr>Lumicera Health Services\u003Cbr>855-847-9553\u003Cbr>[Lumicera.com](Lumicera.com) |\n\nPrescription Drug Schedule of Benefits – HDHP Option  \n\n|  | DOMESTIC PHARMACY\u003Cbr>(Subject to the Allowed Amount)\u003Cbr>You Pay | PARTICIPATING PHARMACY\u003Cbr>(Subject to the Allowed Amount)\u003Cbr>You Pay | NONPARTICIPATING\u003Cbr>PHARMACY\u003Cbr>(Subject to the Allowed Amount)\u003Cbr>You Pay |\n| --- | --- | --- | --- |\n| CALENDAR YEAR DEDUCTIBLE\u003Cbr>(Medical and Prescription Drug combined) |  |  |  |\n| Individual | $1,800 |  | Not Covered |\n| Two-person | $3,600 |  | Not Covered |\n| Employee plus Children | $3,600 |  | Not Covered |\n| Family | $3,600 |  | Not Covered |\n| If you have two-person, Employee plus Children, or family coverage, each person within a family or any combination of family members must satisfy the two-person, Employee plus Children, or family Deductible stated above before the Plan will begin to pay any Covered expense for any covered family member for the Calendar Year. |  |  |  |\n| If you use a combination of Domestic Network Providers, Participating Providers and Non-Participating Providers, the total Deductible amount required to be paid for Domestic Network Providers and Participating Providers will never exceed the amount shown above for Participating Providers; however, the total Deductible amount required to be paid for Non-Participating Providers is separate from the Domestic Network Provider and Participating Provider Deductible amounts (combined) and are not combined. This means that you will be required to satisfy the Deductible amount for Domestic Network Providers and Participating Providers (combined) and Non-Participating Providers separately. The amounts you pay towards satisfaction of the Domestic Network Provider Deductible and Participating Provider Deductible (combined) do not count towards satisfaction of the Non-Participating Provider Deductible and the amounts you pay towards ","cbCair7JwmshYg7M","https://ap.wps.com/l/cbCair7JwmshYg7M","pdf",799359,19,"English","# Introduction\n## Prescription drug benefits overview\n## Plan rights, amendments, and termination\n# Contact Information\n## Customer Care and prescription claims\n## Pharmacy and member portal resources\n# Prescription Drug Schedule of Benefits – HDHP Option\n## Calendar year deductible\n## Calendar year out-of-pocket limits","[{\"question\":\"When do the prescription drug benefits described in the booklet take effect?\",\"answer\":\"The benefits are effective January 1, 2026.\"},{\"question\":\"What document should be referenced for more information about prescription drug benefits and related coverage?\",\"answer\":\"Use the Summary Plan Description for the University of Rochester Welfare Benefits Plan (the wrap document SPD) for additional details unless this booklet addresses something otherwise.\"},{\"question\":\"What happens to covered person rights if the Plan is terminated?\",\"answer\":\"Rights of a Covered Person are limited to expenses incurred before the termination date.\"}]","HSA RX SPD Navitus | PDF",7]