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The prescription drug card co-pays are based upon the discounted charges negotiated by the Prescription Drug Administrator. The prescription drug card co-pays do not apply toward the participant’s major medical deductible or out-of-pocket expense amount. Any benefits that are paid under this prescription drug card program will be applied to the participant’s combined medical and drug lifetime maximum benefit of $5 million.
c) The HDHP Plan options. If you are enrolled in any of the HDHP plans, benefits will be provided for covered drugs and medicines purchased for your use as an outpatient from a participating pharmacy using the Plan’s Prescription Drug Card Program. Insulin and insulin syringes are also covered, even though a prescription may not be required by law. There are no benefits for any prescriptions purchased from non-participating pharmacies or for any claims for prescription drugs that are not filed electronically using the Plan’s Prescription Drug Card Program.
Prescription drug benefits are provided only through the prescription drug card program. With this prescription drug card program, participants pay a prescription drug card co-pay of 20% per prescription of the cost of any covered generic and brand prescription, subject to certain minimums, maximums and other limitations. Participants must first satisfy their deductible before they can receive any benefits under these HDHP programs.
The 20% co-pay per prescription requirement for this prescription drug card program is applicable to all covered outpatient prescription drugs, whether purchased through a retail participating pharmacy or a mail participating pharmacy. Benefits for each retail prescription are limited to a 30 consecutive day supply of that drug. Benefits for each mail service prescription are limited to a 90 consecutive day supply of that drug. The minimum co-pay charged by the Plan is $5 per prescription for up to a 30 day supply and $10 per prescription for between a 31 day supply and a 90 day supply. The maximum co-pay charged by the Plan is $100 per prescription for up to a 30 day supply and $200 per prescription for between a 31 day supply and a 90 day supply.
If you choose a brand prescription drug when a generic equivalent is available, you will be responsible for the 20% co-payment plus the difference in the cost between the brand drug and its generic equivalent. The difference in the cost between the brand drug and its generic equivalent is solely your responsibility to pay, and will NOT be applied toward any calendar year maximum out-of-pocket.
Maximum co-payment and maximum out-of-pocket amounts exclude the difference between the generic and brand drug cost. The participant is responsible for paying this difference if a brand drug is selected when a generic equivalent is available. This amount is in addition to the 20% co-payment.
The prescription drug card co-pays are based upon the discounted charges negotiated by the Prescription Drug Administrator. Once the calendar year deductible has been met, the prescription drug card co-pays do apply toward the participant’s out-of-pocket expense amount. Any benefits that are paid
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