Prescription Benefit for National Benefit Fund Members
Change to CVS Caremark
Your Fund has changed pharmacy benefit providers from Express Scripts to CVS Caremark effective July 1, 2024. Visit the 1199SEIU CVS Caremark member portal at Caremark.com/StartNow.
The Preferred Drug List (PDL)
Have your doctor prescribe preferred drugs on the 1199SEIU Preferred Drug List (PDL). Share this list with your doctor and work together to find the best covered option for you. If your doctor prescribes a drug in a category covered by the Benefit Fund but you don’t see it on the Preferred Drug List, just ask your doctor to prescribe any generic medication or a brand-name if there are no generics available.
The 90-Day Rx Solution
Fill long-term medications through The 90-Day Rx Solution, the Benefit Fund’s maintenance drug program. Ask your doctor to write your prescription for a three-month supply with three refills (a year’s supply in total), and fill it through CVS Caremark Mail Service Pharmacy, or order and pick up your prescription at any CVS, Rite Aid, Walgreens or Duane Reade pharmacy nationwide.
Participating Pharmacies
Fill short-term prescriptions at participating pharmacies.
Prior Authorization
Some medications and services require prior authorization. If your doctor thinks you need a medication that is not on the Preferred Drug List, call CVS Caremark at (833) 250-3237 or CVS Specialty at (855) 299-3262.
Specialty, Step Therapy and Quantity Duration Drugs
In order to continue to safeguard your health while providing you access to the medications you need, we use prescription programs such as our specialty medications list and drug quantity management drug list.
Who Is Eligible?
Family Coverage — Wage Class I
Wage Class II and III are not covered
Not Sure What Wage Class You Are?
Check the front of your Health Benefits ID Card, or click here for an explanation.
Additional Resources
- Summary Plan Description (SPD)
- Overview
- Prescription Drug Reimbursement Form (Direct Claim Form)
- Summary of Benefits and Coverage (SBC)
- Pharmacist Authority to Administer Vaccines by State New
Reimbursement for Drugs Purchased on or Before June 30, 2024
Use the Express Scripts Direct Claim Reimbursement Form for drugs purchased on or before June 30, 2024. For purchases on or after July 1, 2024, use the related CVS Caremark form above.
Access Care from the Comfort of Your Home
If you are a National Benefit Fund, Greater New York Benefit Fund or Home Care Benefit Fund member, you can schedule a virtual visit with any hospital or provider in our 1199SEIU Benefit Fund network, wherever you may be. This is in addition to your Teladoc benefit.
Your Benefits
Medical Benefit
Access to more than 30,000 Benefit Fund providers throughout New York City, Westchester and Long Island.
Mental and Behavioral Health
Comprehensive support through talk therapy, inpatient and outpatient treatment programs and coordinated care.
Prescription Benefit
Full prescription coverage with no co-payments when you use preferred drugs where available.
Dental Benefit
A choice of two plans—EmblemHealth or Aetna DMO—providing basic care, including cleanings, exams and restorative services.
Vision Benefit
Eye exams and glasses or contact lenses every two years.
Life Insurance
Life insurance benefit based on Wage Class.
Keeping Your Coverage
COBRA Continuation Coverage
COBRA allows you to extend your health benefits when your Benefit Fund coverage ends due to a “qualifying event.”
Disability
This benefit provides a financial cushion if you are temporarily unable to work due to non-work-related accidents, injury or illness.
Paid Family Leave
New York State’s Paid Family Leave (PFL) benefit is administered at no cost to NBF members.
Workers' Compensation
Provided through your employer, this benefit provides health and wage benefits if you are injured or become ill at work.