CVS/SSI Retiree Benefits

What’s New?
CVS plan changes for EUTF non-Medicare retirees effective January 1, 2022:

  1. Updated the coordination of benefits for members who have EUTF coverage as secondary coverage. Copayment may change depending on primary coverage.
  2. Implemented the Drug Exclusion Plan Design which excludes drugs with limited clinical value. (Targeted drugs will no longer be covered by the plan.) Notification will be mailed to members affected by this change in November 2021.
For EUTF Members
CVS/SSI PlanJanuary 1 - December 31, 2022January 1 - December 31, 2021
EUTF SSI Prescription Drug Plan (Medicare)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, 2022January 1 - December 31, 2021
HSTA VB SSI Prescription Drug Plan (Medicare)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