MILA : WHAT IS COVERED

	Benefits Summary


	What Is Covered

Explanation of Terms

Covered Medical Services

Other Medical Services

Non-Routine Care and Services

What is Covered Under the Behavioral Health Program

The Prescription Drug Program

Types of Medications

Prescription Brand Deductible and Generic Substitution

Purchasing Prescriptions

Using an In-Network Retail Pharmacy

Using an Out-of-Network Retail Pharmacy

Using the Mail Service

When You Must Use the Mail Service

Exceptions to Mandatory Mail Service

Paying for Your Prescription Drugs through the Mail Service Pharmacy

Covered Medications

When to Get Prior Approval for a Prescription

Medical Expensese Not Covered Under the Plan

Charges Not Covered in the Behavioral Health Program

Charges Not Covered in the Prescription Drug Program

Coordination of Benefits

Third Party Reimbursement and Subrogation


	Participation Under the Plan


	Claims and Appeals


	Your Rights Under ERISA


	Administrative Information


	Glossary

WHAT IS COVERED

The Prescription Drug Program

All MILA Medical Plan Members receive prescription drug coverage through Caremark®. Prescription drug coverage is the same whether you are covered under the Premier, Basic or MILA Medicare Wrap-Around Plan. The copayment amounts are higher and the deductible operates differently if you are covered by the Core Plan.

For your convenience, there are several ways you may contact Caremark®:

Call a Caremark® customer service representative — available 24-hours a day, seven days a week

1-866-875-MILA (6452) Toll-free
1-800-231-4403 for TDD Users

Use the interactive voice response system to refill an order or check the status of an order—available 24-hours a day, seven days a week.
Visit Caremark®’s website at www.caremark.com to fill prescriptions, check prescription history, shipping status or drug pricing.