CVS Active Benefits

What’s New?
CVS plan changes for EUTF and HSTA VB Actives effective July 1, 2021:

  1. Added 100% coverage of Exemestane 25mg and Anastrozole 1mg for women 35 years or older when verified that the medication is used for breast cancer prevention under the EUTF and HSTA VB plans. Members must use an exception process to validate preventive use.
  2. Updated the coordination of benefits for members who have EUTF coverage as secondary coverage. Copays may be subject to change and may increase or decrease depending upon primary coverage.
  3. Increased the maximum out-of-pocket (MOOP) from $2,900/$5,800 (individual/family) to $3,150/$6,300 for the EUTF 75/25 plan (effective January 1, 2021).
  4. Excluded Glumetza (Metformin ER modified-release tablets), Fortamet (Metformin ER osmotic tablets), and their respective generic formulations from all EUTF active plans (effective January 1, 2021).
For EUTF Members
CVS PlanJuly 1, 2021 - June 30, 2022July 1, 2020 - June 30, 2021
EUTF CVS 90/10 PPO PlanSummary of Benefits and Coverage

Benefits at a Glance
Summary of Benefits and Coverage

Benefits at a Glance
EUTF CVS 80/20 PPO PlanSummary of Benefits and Coverage

Benefits at a Glance
Summary of Benefits and Coverage

Benefits at a Glance
EUTF CVS 75/25 PPO PlanSummary of Benefits and Coverage

Benefits at a Glance
Summary of Benefits and Coverage

Benefits at a Glance
EUTF CVS HMO PlanSummary of Benefits and Coverage

Benefits at a Glance
Summary of Benefits and Coverage

Benefits at a Glance
For HSTA VB Members
CVS PlanJuly 1, 2021 - June 30, 2022July 1, 2020 - June 30, 2021
HSTA VB CVS 90/10 PPO PlanSummary of Benefits and Coverage

Benefits at a Glance
Summary of Benefits and Coverage

Benefits at a Glance
HSTA VB CVS 80/20 PPO PlanSummary of Benefits and Coverage

Benefits at a Glance
Summary of Benefits and Coverage

Benefits at a Glance