The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
You will need to pay for the prescription in full at the time of purchase and then file a
claim with Medco if:
• you receive services from a participating Retail Pharmacy, but don’t show your Medco
ID card;
• you use a non-participating Retail Pharmacy; or
• you receive a compounded prescription drug that the pharmacy didn’t submit to Medco.
Claim forms are available by calling Medco at 1-800-864-1404 or online at www.medco.com.
To be eligible for payment, claims must be received within 12 months from the date of service.
Be sure to include your name, the patient’s name and the member ID from your Medco ID card.
Send your original receipt (making a copy for your records) along with a completed Medco
claim form to:
Medco Health Solutions
P.O. Box 14711
Lexington, KY 40512
Upon receipt, Medco will process your claim. Your reimbursement will be based on the
allowed amount had you used a participating Retail Pharmacy and presented your Medco
ID card, minus your responsibility of 50% coinsurance ($50 minimum, no maximum); or
the full cost if less than the minimum. You will be responsible for any amounts that exceed
the allowed amount. In addition, Medco will apply any additional criteria/provisions that
your medication would have been subject to as noted throughout the “Pharmacy” section
in this SPD. You will receive an Explanation of Benefits (EOB) within 30 days of receiving
your claim.
For information on filing medical claims, see the “Filing Health Care Claims – BCBS” section in
this SPD.
When You Have Other Coverage – Medco
If you or your dependents are covered by a U.S. Bank option and by another group health plan,
the U.S. Bank option will not coordinate its payment for pharmacy-related expenses with those
of the other group plan. Therefore, at the time a prescription order is placed (retail or mail order)
and you use the U.S. Bank Medco ID card, the U.S. Bank option will pay as primary. If you use
the pharmacy ID card from the other group plan, no further benefits will be considered for
payment from the U.S. Bank option. The same would apply if you or your dependents are
covered by one of these options along with participation in various other health plans/programs
(i.e., Medical Assistance program, State Agency program, Medicaid, etc.).
For information related to medical services, see the “When You Have Other Coverage – BCBS”
section in this SPD.
When You Have Other Coverage – Medicare Part B Program
Medicare Covered Drugs
Certain drugs and supplies are covered by Medicare Part B including diabetic supplies, nebulizer
solutions, certain immunosuppressant drugs used post-transplant and certain oral anti-cancer
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