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

When You Must Use the Mail Service

Except for insulin and for the other medications listed below that you can buy either at a retail pharmacy or through the mail, all maintenance medications must be ordered through the Plan’s mail service after they have been filled and refilled once. Examples of maintenance medications that must be filled through the mail service are:

Medications taken on a regular basis for chronic conditions such as high blood pressure, arthritis, diabetes and asthma.
Diabetic blood sugar level test strips must also be ordered through the mail service.

To get started, you may fill an initial prescription of a maintenance medication in person at a pharmacy and receive up to a 30-day supply. You also may order one refill at a retail pharmacy. After that, you must order refills through the mail service program. Except for prescription medications required for chemotherapy, mail service refills are limited to a 90-day supply.