Mail Order Program. Except as provided in Section 11.4, all Members have the option of ordering Covered Prescription Drugs via mail order. A Member may obtain up to a twelve (12) month supply of contraceptives at one time. SAMPLE
Mail Order Program. If You elect to use the mail- order service, You must mail Your Prescription Order to the address provided on the mail- order prescription form and send in Your payment for each prescription filled or refilled. Each prescription or refill is subject to the Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any applicable pricing differences, payable by Member directly to the mail- order Pharmacy. Some drugs may not be available through the mail- order program. If You have any questions about this mail- order program, need assistance in determining the amount of Your payment, or need to obtain the mail- order prescription claim form, You may access the website at xxx.xxxxxx.xxx/xxxxxx or contact customer service at the toll- free number on Your identification card. Mail the completed form, Your Prescription Order(s) and payment to the address indicated on the form. Prescription Drugs Purchased Outside of the Service Area. HMO will reimburse You for the Allowable Amount of the prescription drugs less the Out- of- Area Drug Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS, for covered prescription drugs which You purchase outside of the Service Area. You must submit a completed claim form to HMO, including Your name, the prescribing authorized Health Care Practitioner’s name, the date of purchase, NDC of the drug, and itemized receipts indicating the total cost of the prescription within ninety (90) days of the date of purchase to qualify for reimbursement under the PHARMACY BENEFITS. You may access the website at xxx.xxxxxx.xxx/xxxxxx to obtain a prescription drug claim form. Your Cost
Mail Order Program. All Members have the option of ordering Prescription Drugs via mail order. Members ordering Prescription Drugs through the mail order program will be entitled to a thirty- four (34) day supply for non-Maintenance Drugs and a ninety (90) day supply for Maintenance Drugs.
Mail Order Program. Co-pay per prescription—90 Day Supply Generic $10.00 Formulary Brand $20.00 Non- Formulary Brand $50.00 Layoff Classifications APPENDIX L A. A1 Account Clerk
Mail Order Program. If You elect to use the mail-order service, You must mail Your Prescription Order to the address provided on the mail-order prescription form and send in Your payment for each prescription filled or refilled. Each prescription or refill is subject to the Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS and any applicable pricing differences, payable by Member directly to the mail order Pharmacy. Some drugs may not be available through the mail-order program. If You have any questions about this mail-order program, need assistance in determining the amount of Your payment, or need to obtain the mail-order prescription claim form, access the website at xxx.xxxxxx.xxx or contact customer service at the toll-free number on Your identification card. Mail the completed form, Your Prescription Order(s) and payment to the address indicated on the form. Specialty Pharmacy Program. The Specialty Drug delivery service integrates Specialty Drug benefits with the Member’s overall medical and prescription drug benefits. This program provides delivery of medications directly from the Specialty Pharmacy Provider to Your Health Care Practitioner, administration location or to the Member that is undergoing treatment for a complex Medical Condition. The HMO Specialty Pharmacy Program delivery service offers: • Coordination of coverage between You, Your Health Care Practitioner and HMO, • Educational materials about the patient’s particular condition and information about managing potential medication side effects, • Syringes, sharps containers, alcohol swabs and other supplies with every shipment for FDA approved self-injectable medications, and • Access to a pharmacist for urgent medication issues 24 hours a day, 7 days a week, 365 days each year. The Drug List which includes these Specialty Drugs is available by accessing the website at xxxxx://xxx.xxxxxx.xxx/member/prescription-drug-plan-information/drug-lists or by contacting customer service at the toll-free number on Your identification card. Your cost will be the applicable Copayment shown in the Schedule of Copayments and Benefit Limits as well as any applicable pricing differences. Prescription Drugs Purchased Outside of the Service Area. HMO will reimburse You for the Allowable Amount of the prescription drugs less the Out-of-Area Drug Copayment shown in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS, for covered prescription drugs which You purchase outside of the Service Area. You must submit a com...
Mail Order Program. Co-pay per prescription—90 Day Supply Generic $10.00 Formulary Brand $20.00 Non- Formulary Brand $50.00 A Absence Without Leave Grounds for Removal, Suspension and Reduction 25 ABSENTEEISM REPORTING 47 AGREEMENT 2 ALL-PURPOSE LEAVE FORM 57 APPENDIX A Grievance Form 00 XXXXXXXX X 54 APPENDIX C Conference Attendance Request Form 56 APPENDIX D All-Purpose Leave Form 00 XXXXXXXX X Tuition Pay Form 58 APPENDIX F Comprehensive Major Medical Benefits 59 APPENDIX G Prescription Drug Benefits 60 APPENDIX H Memorandum of Understanding 61 ASSAULT LEAVE 11 ASSOCIATION LEAVE 18 ASSOCIATION RIGHTS 8 B Base Salary SALARY 35 BOARD RIGHTS 9 Bonus Payment SALARY 35 C.1. 240-Day Salary Schedule For All PCEADD Unit B Employees 36 C.2. 240-Day Salary Schedule Effective September 1, 2010 BASE: $44,500 37 C.3. SSAs hired on or after September 1, 2020 37 CALENDAR 22 CASELOAD REVIEW 50 CONFERENCE ATTENDANCE REQUEST FORM 56 CONTRACT YEAR 22 Corrective Action For All Employees 62 PROBATION 24 COURT LEAVE 12 D Definitions Removal,Suspension and Reduction 25 DEFINITIONS 4 DISAGREEMENT 3 DRUG-FREE WORKPLACE 45 Duration PROBATION 24 E Employee Appeal Grounds for Removal, Suspension and Reduction 26 EQUIPMENT 47 Exceptions Grounds for Removal, Suspension and Reduction 26 Exempt Employees HOURS OF WORK--SUPPORT ADMINISTRATORS 38 F FACILITIES AND CONDITIONS 45 FAMILY MEDICAL LEAVE ACT (FMLA) 18 Flexible Schedule 38 FORMAL PROCEDURE 4 XXXXX XXX 0 XXXXX XXXXX 0 XXXXX XXX 5 MEDIATION OPTION 5 RECORDS 6 STIPULATIONS 7 G GRIEVANCE FORM 53 GRIEVANCE PROCEDURE 4 Grounds for Removal, Suspension, and Reduction 25 H Hepatitis B 33 HOURS OF WORK—SERVICE AND SUPPORT ADMINISTRATORS 38 EXEMPT EMPLOYEES 38 FLEXIBLE SCHEDULE 38 WORKWEEK 38 I INFORMAL PROCEDURE 4 INSURANCES 42 J JOB DESCRIPTIONS 29 L LABOR/MANAGEMENT RELATIONS COMMITTEE 32 LAYOFF 27 LEAVE FORM XXX-XXXXXXX 00 LEAVE WITHOUT PAY 17 N NEGOTIATIONS PROCEDURE 2 NEGOTIATIONS SCHEDULE 2 O ORGANIZATIONAL STRUCTURE 2 P Past Experience SALARY 35 PERFORMANCE EVALUATIONS 21 Personal Leave SSA ON-CALL PROVISIONS 40 PERSONAL LEAVE 14 PERSONNEL FILES AND COMPLAINTS 22 PHYSICAL EXAMINATION/TB TESTS/VACCINATIONS 33 Position Seniority LAYOFF 28 Probation 24 PROBATION/REMOVAL/SUSPENSION/REDUCTION 24 PROCESS OF ASSOCIATION AND AFFILIATE DUES 8 PROFESSIONAL DEVELOPMENT PROGRAM 30 PROFESSIONAL LEAVE 11 PURCHASING POLICY 47 Purpose PROBATION 24 R Recall LAYOFF 28 RECOGNITION 1 Reinstatement Rights LEAVE WITHOUT PAY 18 REMOTE WORKING 47 Removal, Suspension and Red...
Mail Order Program. Members may purchase refills for self-administered maintenance drugs covered under sections F-1(b)(i), F-1(b)(ii), F-1(c), and F-1(e) for a 90-consecutive-day supply by mail order to the Members home upon payment of an amount that member would pay for a 60-consecutive-day supply.
