Common use of Emergency Prescriptions Clause in Contracts

Emergency Prescriptions. Emergency prescriptions are covered subject to the following terms: When a Member needs a prescription filled in an emergency or Urgent Care situation, or when the Member is traveling outside of the HMO Service Area, HMO will reimburse the Member as described below. When a Member obtains an emergency or out-of-area Urgent Care prescription at a non- Participating Retail Pharmacy, Member must directly pay the pharmacy in full for the cost of the prescription. Member is responsible for submitting a request for reimbursement in writing to HMO with a receipt for the cost of the prescription. Reimbursement requests are subject to professional review by HMO to determine if the event meets HMO’s requirements. Upon approval of the claim, HMO will directly reimburse the Member 100% of the cost of the prescription, less the applicable Copayment specified below and any Brand Name Prescription Drug cost differentials as applicable. Coverage for items obtained from a non-Participating pharmacy is limited to items obtained in connection with covered emergency and out-of-area Urgent Care services. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area. When a Member obtains an emergency or Urgent Care prescription at any Participating Retail Pharmacy, including an out-of-area Participating Retail Pharmacy, Member will pay to the Participating Retail Pharmacy the Copayment(s), plus the Brand Name Prescription Drug cost differentials where applicable and as described below. Members are required to present their ID card at the time the prescription is filled. HMO will not cover claims submitted as a direct reimbursement request from a Member for a prescription purchased at a Participating Retail Pharmacy except upon professional review and approval by HMO in its sole discretion. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area.

Emergency Prescriptions. Emergency prescriptions are covered subject to the following terms: When a Member needs a prescription filled in an emergency or Urgent Care situation, or when the Member is traveling outside of the HMO Service Area, HMO will reimburse the Member as described below. When a Member obtains an emergency or out-of-area Urgent Care prescription at a non- Participating Retail Pharmacy, Member must directly pay the pharmacy in full for the cost of the prescription. Member is responsible for submitting a request for reimbursement in writing to HMO with a receipt for the cost of the prescription. Reimbursement requests are subject to professional review by HMO to determine if the event meets HMO’s requirements. Upon approval of the claim, HMO will directly reimburse the Member 100% of the cost of the prescription, less the applicable Copayment specified below and any Brand Name Prescription Drug cost differentials as applicablein the Copayments section of this Rider. Coverage for items obtained from a non-Participating pharmacy is limited to items obtained in connection with covered emergency and out-of-area Urgent Care services. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area. When a Member obtains an emergency or Urgent Care prescription at any Participating Retail Pharmacy, including an out-of-area Participating Retail Pharmacy, Member will pay to the Participating Retail Pharmacy the Copayment(s), plus ) specified in the Brand Name Prescription Drug cost differentials where applicable and as described belowCopayments section of this Rider. Members are required to present their ID card at the time the prescription is filled. HMO will not cover claims submitted as a direct reimbursement request from a Member for a prescription purchased at a Participating Retail Pharmacy except upon professional review and approval by HMO in its sole discretionHMO. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area.

Emergency Prescriptions. Emergency prescriptions are covered subject to the following terms: When a Member needs a prescription filled in an emergency or Urgent Care situation, or when the Member is traveling outside of the HMO Service Area, HMO will reimburse the Member as described below. When a Member obtains an emergency or out-of-area Urgent Care prescription at a non- non-Participating Retail Pharmacy, Member must directly pay the pharmacy in full for the cost of the prescription. Member is responsible for submitting a request for reimbursement in writing to HMO with a receipt for the cost of the prescription. Reimbursement requests are subject to professional review by HMO to determine if the event meets HMO’s requirements. Upon approval of the claim, HMO will directly reimburse the Member 100% of the cost of the prescription, less the applicable Copayment specified below and any Brand Name Prescription Drug cost differentials as applicable. Coverage for items obtained from a non-Participating pharmacy is limited to items obtained in connection with covered emergency and out-of-area Urgent Care services. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area. When a Member obtains an emergency or Urgent Care prescription at any Participating Retail Pharmacy, including an out-of-area Participating Retail Pharmacy, Member will pay to the Participating Retail Pharmacy the Copayment(s), plus the Brand Name Prescription Drug cost differentials where applicable and as described below. Members are required to present their ID card at the time the prescription is filled. HMO will not cover claims Emergency or Urgent Care prescriptions submitted as a direct reimbursement request from a Member for a prescription purchased at a Participating Retail Pharmacy except upon professional review and approval by HMO in its sole discretionwill be reimbursed at the Participating Retail Pharmacy’s Contracted Rate, less the applicable Copayment. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area.

Emergency Prescriptions. Emergency prescriptions are covered subject to the following terms: When a Member needs a prescription filled in an emergency or Urgent Care situation, or when the Member is traveling outside of the HMO Service Area, HMO will reimburse the Member as described below. When a Member obtains an emergency or out-of-area Urgent Care prescription at a non- non-Participating Retail Pharmacy, Member must directly pay the pharmacy in full for the cost of the prescription. Member is responsible for submitting a request for reimbursement in writing to HMO with a receipt for the cost of the prescription. Reimbursement requests are subject to professional review by HMO to determine if the event meets HMO’s requirements. Upon approval of the claim, HMO will directly reimburse the Member 100% of the cost of the prescription, less the applicable Copayment specified below and any Brand Name Prescription Drug cost differentials as applicable. Coverage for items obtained from a non-Participating pharmacy is limited to items obtained in connection with covered emergency and out-of-area Urgent Care services. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area. When a Member obtains an emergency or Urgent Care prescription at any Participating Retail Pharmacy, including an out-of-area Participating Retail Pharmacy, Member will pay to the Participating Retail Pharmacy the Copayment(s), plus the Brand Name Prescription Drug cost differentials where applicable and as described below. Members are required to present their ID card at the time the prescription is filled. HMO will not cover claims submitted as a direct reimbursement request from a Member for a prescription purchased at a Participating Retail Pharmacy except upon professional review and approval by HMO in its sole discretion. Members must access a Participating Retail Pharmacy for Urgent Care prescriptions inside the HMO Service Area.