MILA : WHAT IS NOT COVERED

	Benefits Summary


	What Is Covered


	What is Not Covered

Medical Expensese Not Covered Under the Plan

Charges Not Covered in the Behavioral Health Program

Charges Not Covered in the Prescription Drug Program

Dental Charges and Services Not Covered Under the Plan

Vision Charges and Services Not Covered Under the Plan

Coordination of Benefits

Third Party Reimbursement and Subrogation

Waiver of Benefits


	Participation Under the Plan


	Claims and Appeals


	Your Rights Under ERISA


	Administrative Information


	Glossary

WHAT IS NOT COVERED

Charges Not Covered in the Prescription Drug Program

Listed below are medications the MILA National Health Plan does not cover under the Prescription Drug Program:

Drugs that do not require prescriptions, such as over-the-counter remedies, or for which there is a generic equivalent drug that is available in non-prescription form;
Drugs for the treatment of pain (delivered as patches, lotions or creams), the active ingredients of which are sold over the counter but one or more of the active ingredients are in an increased concentration;
Compound prescriptions that do not have at least one ingredient that is a legend drug requiring a prescription under federal or state law or for which you have not received prior authorization from the Claims Administrator pursuant to the Plan’s requirements;
Drugs not included in the MILA/CVS Caremark Prescription Drug Formulary;
Drugs that are covered under another part of the MILA National Health Plan or that are limited or excluded because they are experimental, investigational or not medically necessary;
Drugs that are covered under Workers’ Compensation or any government program (state, federal or municipal) that does not claim secondary payer status;
Drugs or devices for cosmetic purposes, hair growth, smoking cessation, anti-obesity, weight control, and contraception except for oral contraceptives and the specific products Nuva-Ring and Ortho Evra;
Drugs not approved by the U.S. Food and Drug Administration (FDA) or not approved by the FDA for the condition, dose, routine and frequency for which they are being prescribed;
Drugs provided at no charge to you or for which you would not have to pay in the absence of this or similar coverage;
Drugs required as a result of an act of war, declared or undeclared;
Food, diet and nutritional supplements except prescription vitamins and minerals; and
Natural remedies (naturopathic) and homeopathic services, substances and supplies.

Note

If you have questions about the Prescription Drug Program or to determine if a particular medication is covered, you can call CVS Caremark directly at 1-866-875-MILA (6452).