Common use of Outpatient Prescription Drug Benefits Clause in Contracts

Outpatient Prescription Drug Benefits. This benefit includes access to Blue Shield’s Participating Pharmacy Network. By presenting your Blue Shield Identifi- cation Card to a Participating Pharmacy you will pay Blue Shield’s contracted rate for covered medication. This will significantly reduce your out of pocket costs for covered medications. Please see the section entitled “Obtaining Out- patient Prescription Drugs at a Participating Pharmacy” for more details. The following prescription drug benefit is separate from the Shield Spectrum PPO 5500 coverage. The Calendar Year Maximum Copayment and Medical Plan Deductible provisions do not apply to the outpatient prescrip- tion drug benefit; however, the general provisions and exclu- sions of the Shield Spectrum PPO 5500 contract shall apply. Benefits for covered Brand Name Drugs are subject to a per Member, per Calendar Year Brand Name Drug Deductible as shown in the Summary of Benefits. Note: Except for covered emergencies, no benefits are pro- vided for drugs received from Non-Participating Pharmacies.

Outpatient Prescription Drug Benefits. This benefit includes access to Blue Shield’s Participating Pharmacy Network. By presenting your Blue Shield Identifi- cation Card to a Participating Pharmacy you will pay Blue Shield’s contracted rate for covered medication. This will significantly reduce your out of pocket costs for covered medications. Please see the section entitled “Obtaining Out- patient Prescription Drugs at a Participating Pharmacy” for more details. The following prescription drug benefit is separate from the Shield Spectrum PPO 5500 Plan coverage. The Calendar Year Maximum Copayment and Medical Plan Deductible provisions do not apply to the outpatient prescrip- tion drug benefit; however, the general provisions and exclu- sions of the Shield Spectrum PPO 5500 Plan contract shall apply. Benefits for covered Brand Name Drugs are subject to a per Member, per Calendar Year Brand Name Drug Deductible as shown in the Summary of Benefits. Note: Except for covered emergencies, no benefits are pro- vided for drugs received from Non-Participating Pharmacies.