Prescription Benefit

Effective May 1, 2004, your Prescription Drug Program is administered by Caremark.

Be sure to also review your Prescription Drugs and Medicines Benefit in your Summary Plan Description for a complete listing of coverage and limitations.

Retail Program

Mail Service Program

When to Use

For prescriptions purchased at a local pharmacy

For maintenance or long-term medications

You Pay

• 10% ($7.50 minimum / $100 maximum) for each generic prescription
• 20% ($20.00 minimum / $100 maximum) for each brand name prescription on the Preferred Drug List
• 30% ($35.00 minimum / $100 maximum) for each brand name prescription no on the Preferred Drug List

• $20.00 for each generic
  prescription
• $40.00 for each brand name prescription on the Preferred Drug List
• $80.00 for each brand name prescription not on the Preferred Drug List