Prescription Drug Benefit. The program will pay the ingredient cost of eligible drugs (including oral contraceptives and insulin), you are responsible to pay the co-pay, which will be the equivalent of the pharmacists professional fee plus any applicable surcharge. The drug plan provides coverage for most drugs which require a prescription by law, however, but does not provide coverage for over-the-counter drugs, cough or cold preparations or nicotine products. Some drugs may require special authorization, details of the special authorization process are outlined in the Employee Benefits Program Booklet. You and your insured dependents are covered for the following vision care expenses:
Prescription Drug Benefit. 1. Faculty members electing any of the Medical Plan options will be covered under a prescription drug benefit plan. The cost of this coverage is included in the employee contribution described in Section 1.B.4. above.
2. Under any of the PPO options, purchases are subject to a co-insurance payment from the employee, but are not subject to an annual deductible, as set forth in Attachments A and B hereto.
3. Under the HDHP, purchases are subject to the annual deductible and may be subject to a co-insurance payment from the employee, as set forth in Attachments A and B hereto.
4. Prescription drug benefits for Faculty members electing a medical benefit plan shall also include coverage for oral contraceptives.
5. The prescription drug benefit provided to employees electing any of the medical plans will include the following features:
a. Medications may be received from either a retail pharmacy or a mail service pharmacy subject to the limitations below. The maximum prescription available at a retail pharmacy is a 30-day supply; the maximum prescription available from the mail service pharmacy is a 90-day supply.
b. Co-insurance levels will be 10% for generic medications, 20% for brand name medications and 40% for brand name medications when a generic equivalent is available. The maximum coinsurance for any single prescription will be $80, except when a brand name medication is prescribed when a generic equivalent is available. In this case, the maximum coinsurance for any single prescription will be $100, unless the physician has written the prescription dispense as written.
c. Benefits will be provided for maintenance medications (whether brand or generic) through a retail pharmacy for a 30-day prescription and two 30-day refills at the retail level. After the initial 90-day period, benefits will be provided for maintenance medications through the mail service pharmacy only.
Prescription Drug Benefit. 1. PDP Sponsor agrees to provide the basic prescription drug coverage as defined under 42 CFR Section 423.100 and, to the extent applicable, supplemental benefits as defined in 42 CFR Section 423.100 and in accordance with Subpart C of 42 CFR Part 423. PDP Sponsor also agrees to provide Part D benefits as described in the PDP Sponsor's bid(s) approved each year by CMS (as referenced in Attachment A, to be replaced each year upon renewal of the contract to reflect the Sponsor's approved bids for the succeeding contract year).
2. PDP Sponsor agrees to calculate and collect beneficiary premiums in accordance with 42 CFR Sections 423.286 and 423.293.
Prescription Drug Benefit. The Employer agrees to pay one hundred percent (100%) of the billed premium, subject to any applicable dispensing fee, toward coverage of each Eligible Employee who qualifies and remains eligible for coverage.
Prescription Drug Benefit. In the event that upon the termination of this Agreement or thereafter during the COBRA Period NMHC has opted out of providing prescription drug benefit coverage as part of its health insurance benefits provided to employees, NMHC shall cause its health insurance provider to provide such benefits under the COBRA benefits provided to Executive and, if such Executive shall be entitled to Severance Compensation or Change in Control Compensation, the cost thereof shall be paid for by NMHC for the duration of the COBRA Period.
Prescription Drug Benefit. 1. Except as provided in this subsection, PDP Sponsor agrees to provide basic prescription drug coverage, as defined under 42 CFR §423.100, under any employer/union-only group PDP, in accordance with Subpart C of 42 CFR Part 423.
(a) CMS agrees that PDP Sponsor will not be subject to the actuarial equivalence requirement set forth in 42 CFR §423.104(e)(5) with respect to any employer/union-only group PDP and may provide less than the defined standard coverage between the deductible and initial coverage limit. PDP Sponsor agrees that its basic prescription drug coverage under any employer/union-only group PDP will satisfy all of the other actuarial equivalence standards set forth in 42 CFR §423.104, including but not limited to the requirement set forth in 42 CFR §423.104(e)(3) that the plan has a total or gross value that is at least equal to the total or gross value of defined standard coverage.
2. CMS agrees that nothing in this Addendum prevents PDP Sponsor from offering benefits in addition to basic prescription drug coverage to employers/unions. Such additional benefits offered pursuant to private agreements between PDP Sponsor and employers/unions will be considered non-Medicare Part D benefits ("non-Medicare Part D benefits"). PDP Sponsor agrees that such additional benefits may not reduce the value of basic prescription drug coverage (e.g., additional benefits cannot impose a cap that would preclude enrollees from realizing the full value of such basic prescription drug coverage).
3. PDP Sponsor agrees that enrollees of employer/union-only group PDPs shall not be charged more than the sum of his or her monthly beneficiary premium attributable to basic prescription drug coverage and 100% of the monthly beneficiary premium attributable to his or her non-Medicare Part D benefits (if any). PDP Sponsor must pass through the direct subsidy payments received from CMS to reduce the amount that the beneficiary pays (or, in those instances where the subscriber to or participant in the employer plan pays premiums on behalf of an eligible spouse or dependent, the amount the subscriber or participant pays).
4. PDP Sponsor agrees that any additional non-Medicare Part D benefits offered to an employer/union will always pay primary to the subsidies provided by CMS to low-income individuals under Subpart P of 42 CFR Part 423 (the "Low-Income Subsidy").
5. PDP Sponsor agrees enrollees of employer/union-only group PDPs will not be permitted to make payment of premium...
Prescription Drug Benefit. Effective not later than December 31, 2002, the Company will arrange through its insurance carrier to provide for prescription drug cards. The current $25.00 annual deductible will be decreased to a 35¢ deductible on each purchase with a dispensing fee cap of $10.00.
Prescription Drug Benefit. Faculty members electing any of the Medical Plan options will be covered under the current prescription drug benefit plan. Purchases are subject to a co-insurance payment from the employee, but are not subject to an annual deductible.
1. Prescription drug benefits for Faculty members electing any medical benefit plans shall also include coverage for oral contraceptives.
2. The prescription drug benefit provided to employees electing any of the medical plans will include the following features:
a. Medications may be received from either a retail pharmacy or a mail service pharmacy subject to the limitations below. The maximum prescription available at a retail pharmacy is a 30-day supply; the maximum prescription available from the mail service pharmacy is a 90-day supply.
b. Co-insurance levels will be 10% for generic medications, 20% for brand name medications and 40% for brand name medications when a generic equivalent is available. The maximum coinsurance for any single prescription will be $60, except when a brand name medication is prescribed when a generic equivalent is available. In this case, the maximum coinsurance for any single prescription will be $100, unless the physician has written the prescription dispense as written.
c. Benefits will be provided for maintenance medications (whether brand or generic) through a retail pharmacy for a 30-day prescription and two 30-day refills at the retail level. After the initial 90-day period, benefits will be provided for maintenance medications through the mail service pharmacy only.
Prescription Drug Benefit. Bargaining unit members electing any medical plan will be eligible to participate in the current prescription program under the terms of the 80/60 PPO for 2018, the 85/60 PPO for 2019, and the 90/70 and HDHP for both 2018 and 2019. Purchases are subject to a co-insurance from the employee, but are not subject to an annual deductible.
1. Prescription drug benefits for full-time bargaining unit members electing medical benefit plans set forth in Article 45 above shall also include coverage for oral contraceptives.
2. The prescription drug benefit provided to employees electing one of the medical plans set forth in Article 45 above will include the following features:
a. Medications may be received from either a retail pharmacy or a mail service pharmacy subject to the limitations below. The maximum prescription available at a retail pharmacy is a 30-day supply; the maximum prescription available from the mail service pharmacy is a 90- day supply.
b. Co-insurance levels will be 10% for generic medications, 20% for brand name medications and 40% for brand name medications only when a generic equivalent is available. The maximum coinsurance for any single prescription will be $60 ($80 in the case of the 85/60 PPO), except when a brand name medication is prescribed when a generic equivalent is available. In this case, the maximum coinsurance for any single prescription will be $100, unless the physician has written the prescription dispense as written. The University may, in its discretion, implement a Generic Step Therapy strategy during the term of this Agreement.
c. Benefits will be provided for maintenance medications (whether brand or generic) through a retail pharmacy for a 30-day prescription and two 30- day refills at the retail level. After the initial 90-day period, benefits will be provided for maintenance medications through the mail service pharmacy only.
Prescription Drug Benefit. 1. PDP Sponsor agrees to provide the basic prescription drug coverage as defined under 42 CFR §423.100 and, to the extent applicable, supplemental benefits as defined in 42 CFR §423.100 and in accordance with Subpart C of 42 CFR Part 423. PDP Sponsor also agrees to provide Part D benefits as described in PDP Sponsor's bid(s) approved each year by CMS (as referenced in Attachment A, to be replaced each year upon renewal of the contract to reflect the Sponsor's approved bids for the succeeding contract year).
2. PDP Sponsor agrees to calculate and collect beneficiary premiums in accordance with 42 CFR §§423.286 and 423.293.
3. PDP Sponsor agrees to maintain administrative and management capabilities sufficient for the organization to organize, implement, and control the financial, marketing, benefit administration, and quality assurance activities related to the delivery of Part D services as required by 42 CFR §423.505(b)(25).
4. PDP Sponsor agrees to provide applicable beneficiaries applicable discounts on applicable drugs in accordance with the requirements of 42 CFR Part 423 Subpart W.
