Benefits for Covered Sample Clauses
Benefits for Covered. Drugs obtained from a Participating Pharmacy are provided up to the maximum day supply limit as shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. HMO has the right to determine the day supply. Payment for benefits covered by HMO may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum day supply limitation. Extended Prescription Drug Supply Program. Your coverage includes benefits for up to a 90-day supply of covered maintenance type drugs purchased from a Participating Pharmacy (which may only include retail or mail order Pharmacies). Each prescription or refill is subject to the Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any applicable pricing differences. Benefits will not be provided for more than a 30-day supply of drugs purchased from a Pharmacy not participating in the extended prescription drug supply program.
Benefits for Covered. Drugs obtained from a Participating Pharmacy are provided up to the maximum day supply limit as shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. HMO has the right to determine the day supply. Payment for benefits covered by HMO may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum day supply limitation. order Pharmacies). Each prescription or refill is subject to the Copayment shown in the Schedule of Benefits will not be provided for more than a 30-day supply of drugs purchased from a Pharmacy not participating in the extended prescription drug supply program.
Benefits for Covered. Hospice Services shall be provided until the earlier of the Covered Person’s death or discharge from Hospice Care. Special Hospice Services Exclusions: No Hospice Care benefits will be provided for:
Benefits for Covered. Drugs obtained from a Participating Pharmacy are provided up to the maximum day supply limit as shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. HMO has the right to determine the day supply. Payment for benefits covered by HMO may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum day supply limitation. management of a chronic illness so they are refilled on the same schedule for a given time period. When necessary to fill a partial Prescription Order to permit synchronization, HMO will prorate the Copayment due for Covered Drugs based on the proportion of days the reduced Prescription Order covers to the regular day supply outlined in the Schedule of Copayments and Benefit Limits. Refills for prescription eye drops to treat a chronic eye disease or condition will be refilled if (1) the original Prescription Order states that additional quantities of the eye drops are needed; (2) the refill does not exceed the total quantity of dosage units authorized by the prescribing Health Care Practitioner on the original Prescription Order, including refills; and (3) the refill is dispensed on or before the last day of the prescribed dosage period. The refills are allowed: • not earlier than the 21st day after the date a Prescription Order for a 30‐day supply is dispensed; or • not earlier than the 42nd day after the date a Prescription Order for a 60‐day supply is dispensed; or • not earlier than the 63rd day after the date a Prescription Order for a 90‐day supply is dispensed. Dispensing Limits. Dispensing limits are based upon FDA dosing recommendations and nationally recognized guidelines. Coverage limits are placed on medications in certain drug categories. Limits may include: quantity of covered medication per prescription, quantity of covered medication in a given time period, or coverage only for Members within a certain age range. Quantities of some drugs are restricted regardless of the quantity ordered by the Health Care Practitioner. To determine if a specific drug is subject to this limitation, You may access the website at ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇.▇▇▇ or contact customer service at the toll‐free number on Your identification card. If Your Health Care Practitioner prescribes a greater quantity of medication than what the dispensing limit allows, You can still get the medication. However, You will be responsible for the full cost of the prescription beyond w...