Dental Coverage
(Adults 19 years of age and older)
Choose one of the following:
Dentcare/Healthplex Plan 
Fund Scheduled Dental Plan
Anthem BC/BS XPO
Emblem Preferred Dental
Home Health Care
$150 for each of three consecutive 24-hour periods up to $450 per calendar year
General Medical Reimbursement
$150 per family per calendar year
Optical Benefit
(Adults 19 years of age and older)
Up to $200 (effective 1/1/2024) per pair of prescription glasses; maximum 1 pair per individual, per calendar year. Limit 4 pairs per family annually, not including pediatric optical benefit.
Optical Vendor Options: (Note: you may use any vendor’s network providers)
Comprehensive Professional Services
General Vision Services
Vision Screening
Pediatric Optical Benefit
(Children under 19 years of age)
No-cost benefit. Must use a network provider.
A pair of prescription glasses annually from a special selection of frames. If the child’s prescription changes during the year, new glasses will be provided without cost.
Up to $300 a year per person for out-of-hospital mental health services (licensed psychiatrist, psychotherapist or psychologist, or certified social worker)
Prescription Drug Benefit
Capital Rx
No Annual Dollar Maximum
(Except Court Employees who receive this benefit through their basic health plan)
Preventative Medications
No co-payments with a doctor’s prescription
Co-payment: Generic, $5 up to a 30-day supply at retail; $10 up to 90-day supply through mail order
Brand Name: 20% for 30-day supply, retail; 20% for 90-day supply mail order
Brand Name Drugs with Generic Equivalent: You pay the difference between the price of the brand name drug and the price of the generic drug at retail and mail order
Proton Pump Inhibitors
Generics only
Specialty Medications
High-cost drugs used to treat complex or rare conditions. First 30-day fill allowed at participating pharmacies; thereafter, refills must be made through Costco Pharmacy (mail order)
Diabetic Medications and Supplies
Members under age 65 are covered by their City Health Insurance Provider
Step Therapy
For certain classes of drug therapies, medication starts with the safest and most cost-effective drug before progressing to more costly or risky therapies. The Fund will only pay for generic drugs in the step therapy drug class. Members and dependents taking brand name drugs prior to January 1, 2014, with no exact generic equivalent please refer to grandfather rules.