Common use of OUTPATIENT PRESCRIPTION DRUG PROGRAM BENEFITS Clause in Contracts

OUTPATIENT PRESCRIPTION DRUG PROGRAM BENEFITS. When you are being treated for an illness or accident, your Physician may pre­ scribe certain drugs or medicines as part of your treatment. Your coverage includes benefits for drugs and supplies which are self‐administered. Benefits will not be provided for any self‐administered drugs dispensed by a Physician. This section of your Certificate explains which drugs and supplies are covered and the benefits that are available for them. Benefits will be provided only if such drugs and supplies are medically necessary. Although you can go to the Pharmacy of your choice, benefits will only be provided for drugs and supplies when purchased through a Participating Phar­ macy. However, benefits for drugs and supplies purchased outside of a Participating Pharmacy network will only be provided in the case of an emer­ gency condition. You can visit the Plan's website at xxx.xxxxxx.xxx for a list of Participating Pharmacies or call the customer service toll‐free number on your identification card. The Pharmacies that are Participating or Specialty Pharma­ cies may change from time to time. You should check with your Pharmacy before obtaining drugs or supplies to make certain of its participation status. The benefits of this section are subject to all of the terms and conditions of this Certificate. Please refer to the DEFINITIONS, ELIGIBILITY and EXCLU­ SIONS — WHAT IS NOT COVERED sections of this Certificate for additional information regarding any limitations and/or special conditions pertaining to your benefits.

OUTPATIENT PRESCRIPTION DRUG PROGRAM BENEFITS. When you are being treated for an illness or accident, your Physician may pre­ scribe certain drugs or medicines as part of your treatment. Your coverage includes benefits for drugs and supplies which are self‐administered. Benefits will not be provided for any self‐administered drugs dispensed by a Physician. This section of your Certificate explains which drugs and supplies are covered and the benefits that are available for them. Benefits will be provided only if such drugs and supplies are medically necessary. Although you can go to the Pharmacy of your choice, benefits will only be provided for drugs and supplies when purchased through a Participating Phar­ macy. However, benefits for drugs and supplies purchased outside of a Participating Pharmacy network will only be provided in the case of an emer­ gency condition. You can visit the Plan's website Web site at xxx.xxxxxx.xxx for a list of Participating Pharmacies or call the customer service Customer Service toll‐free number on your identification card. The Pharmacies that are Participating or Specialty Pharma­ cies Pharmacies may change from time to time. You should check with your Pharmacy before obtaining obtain­ ing drugs or supplies to make certain of its participation status. The benefits of this section are subject to all of the terms and conditions of this Certificate. Please refer to the DEFINITIONS, ELIGIBILITY and EXCLU­ SIONS — WHAT IS NOT COVERED sections of this Certificate for additional information regarding any limitations and/or special conditions pertaining to your benefits.

OUTPATIENT PRESCRIPTION DRUG PROGRAM BENEFITS. When you are being treated for an illness or accident, your Physician may pre­ scribe certain drugs or medicines as part of your treatment. Your coverage includes benefits for drugs and supplies which are self‐administered. Benefits will not be provided for any self‐administered drugs dispensed by a Physician. This section of your Certificate explains which drugs and supplies are covered and the benefits that are available for them. Benefits will be provided only if such drugs and supplies are medically necessary. Although you can go to the Pharmacy of your choice, benefits will only be provided for drugs and supplies when purchased through a Participating Phar­ macy. However, benefits for drugs and supplies purchased outside of a Participating Pharmacy network will only be provided in the case of an emer­ gency condition. You can visit the Plan's website at xxx.xxxxxx.xxx for a list of Participating Pharmacies or call the customer service toll‐free number on your identification card. The Pharmacies that are Participating or Specialty Pharma­ cies Pharmacies may change from time to time. You should check with your Pharmacy before obtaining obtain­ ing drugs or supplies to make certain of its participation status. The benefits of this section are subject to all of the terms and conditions of this Certificate. Please refer to the DEFINITIONS, ELIGIBILITY and EXCLU­ SIONS — WHAT IS NOT COVERED sections of this Certificate for additional information regarding any limitations and/or special conditions pertaining to your benefits.

OUTPATIENT PRESCRIPTION DRUG PROGRAM BENEFITS. When you are being treated for an illness or accident, your Physician may pre­ scribe prescribe certain drugs or medicines as part of your treatment. Your coverage includes benefits for drugs and supplies which are self‐administered. Benefits will not be provided for any self‐administered drugs dispensed by a Physician. This section of your Certificate explains which drugs and supplies are covered and the benefits that are available for them. Benefits will be provided only if such drugs and supplies are medically necessary. Although you can go to the Pharmacy of your choice, benefits will only be provided for drugs and supplies when purchased through a Participating Phar­ macyPharmacy. However, benefits for drugs and supplies purchased outside of a Participating Pharmacy network will only be provided in the case of an emer­ gency emergency condition. You can visit the Plan's website at xxx.xxxxxx.xxx for a list of Participating Pharmacies or call the customer service toll‐free number on your identification card. The Pharmacies that are Participating or Specialty Pharma­ cies Pharmacies may change from time to time. You should check with your Pharmacy before obtaining drugs or supplies to make certain of its participation status. The benefits of this section are subject to all of the terms and conditions of this Certificate. Please refer to the DEFINITIONS, ELIGIBILITY and EXCLU­ SIONS EXCLUSIONS — WHAT IS NOT COVERED sections of this Certificate for additional information regarding any limitations and/or special conditions pertaining to your benefits.

OUTPATIENT PRESCRIPTION DRUG PROGRAM BENEFITS. When you are being treated for an illness or accident, your Physician may pre­ scribe prescribe certain drugs or medicines as part of your treatment. Your coverage includes benefits for drugs and supplies which are self‐administeredself‐ administered. Benefits will not be provided for any self‐administered self‐ administered drugs dispensed by a Physician. This section of your Certificate explains which drugs and supplies are covered and the benefits that are available for them. Benefits will be provided only if such drugs and supplies are medically necessary. Although you can go to the Pharmacy of your choice, benefits will only be provided for drugs and supplies when purchased through a Participating Phar­ macyPharmacy. However, benefits for drugs and supplies purchased outside of a Participating Pharmacy network will only be provided in the case of an emer­ gency conditionEmergency Medical Condition. You can visit the Plan's website at xxx.xxxxxx.xxx for a list of Participating or Specialty Pharmacies or call the customer service toll‐free toll-free number on your identification card. The Pharmacies that are Participating or Specialty Pharma­ cies Providers may change from time to timechange. You should check with your Pharmacy before obtaining drugs or supplies to make certain of its participation status. The benefits of this section are subject to all of the terms and conditions of this Certificate. Please refer to the DEFINITIONS, ELIGIBILITY and EXCLU­ SIONS EXCLUSIONS — WHAT IS NOT COVERED sections of this Certificate for additional information regarding any limitations and/or special conditions pertaining to your benefits.