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

Using an In-Network Retail Pharmacy

If you have a prescription filled (or refilled) at a participating Caremark® pharmacy, you pay the copayment amounts listed in the Chart for your Plan. Just show your Caremark® prescription ID card to the pharmacist and pay your applicable copay; the Plan pays the rest. Remember, a prescription drug deductible may apply depending on the type of medication you are purchasing. See the discussion above for details about how the prescription drug deductible works.