There are two components to the Welfare Fund's plan that affect families with high drug expenses. These are the $1,000 copay cap and the Cost Care Program.
The trustees of the UFT Welfare Fund have instituted a copay cap for all eligible members and their families. Once your family's copays reach $1,000 in out-of-pocket expenditures, the rest of your drugs in Tier 1 and Tier 2 are free for the year. Copays must still be paid for Tier 3 drugs.
Families whose combined prescription-drug claim benefits exceed $1,200 (the total cost of the drugs paid for by the Welfare Fund) during the previous months of December through November automatically are enrolled in the Welfare Fund's Cost Care Program effective in January and receive a Cost Care drug card. (For members and an in-service spouse or domestic partner who is also a member, the threshold is $2,400, due to the special coordination of benefits.)
When a brand-name drug has an approved generic equivalent, you can still get the brand-name drug but you are responsible for the difference in cost between the two drugs in addition to the applicable copays (until you hit the $1,000 annual copay cap).
This difference is known as an ancillary fee and will be charged to you even if you hit the $1,000 copay cap. Your family's status is reviewed every 12 months; if your total claims fall below $1,200 ($2,400 for members with special coordination of benefits), you return automatically to the regular drug plan the following January.