CVS/SSI Retiree Benefits

What’s New?
Effective January 1, 2025:

  • Added a $2,000 per person calendar year maximum out-of-pocket (CY MOOP) to all EUTF and HSTA VB retiree plans. The CY MOOP will apply to specialty and non-specialty drugs.
  • Increased the non-preferred brand copays from $30 to $40 for a 30-day supply under the EUTF non-Medicare and Medicare retiree plans. A 90-day supply will continue to be two times the 30-day copay under the EUTF Medicare retiree plan and at a Retail 90 or Mail Order pharmacy under the EUTF non-Medicare retiree plan.
  • Changed the out-of-network non-specialty member cost share to a 20% coinsurance under the EUTF Medicare retiree plan and a 30% coinsurance under the HSTA VB Medicare retiree plan.
For EUTF Members
CVS/SSI PlanJanuary 1 - December 31, 2025January 1 - December 31, 2024
EUTF SSI Prescription Drug Plan (Medicare)Benefits at a Glance

Summary of Benefits

Evidence of Coverage
Summary of Benefits

Evidence of Coverage
EUTF CVS Prescription Drug Plan (Non-Medicare)Benefits at a GlanceBenefits at a Glance
For HSTA VB Members
CVS/SSI PlanJanuary 1 - December 31, 2025January 1 - December 31, 2024
HSTA VB SSI Prescription Drug Plan (Medicare)Benefits at a Glance

Summary of Benefits

Evidence of Coverage
Summary of Benefits

Evidence of Coverage
HSTA VB CVS Prescription Drug Plan (Non-Medicare)Benefits at a GlanceBenefits at a Glance