PPO II - EmblemHealth

2013 Evidence of Coverage for PPO II) II
SECTION Chapter 6: 3 What you benefi pay ts for are your not covered Part D prescription by the plan? drugs
?
Did you know there are programs to help people pay for their
drugs?
Th ere are programs to help people with limited resources pay for their drugs. Th ese
include “Extra Help” and State Pharmaceutical Assistance Programs. For more
information, see Chapter 2, Section 7.
Are you currently getting help to pay for your drugs?
If you are in a program that helps pay for your drugs, some information in this
Evidence of Coverage about the costs for Part D prescription drugs may not apply
to you. We send you a separate insert, called the “Evidence of Coverage Rider for People
Who Get Extra Help Paying for Prescription Drugs” (also known as the “Low Income
Subsidy Rider” or the “LIS Rider”), which tells you about your drug coverage. If you
don’t have this insert, please call Customer Service and ask for the “LIS Rider.” (Phone
numbers for Customer Service are printed on the back cover of this booklet.)
SECTION 1 INTRODUCTION
Section 1.1 Use this chapter together with other materials
that explain your drug coverage
Th is chapter focuses on what you pay for your Part D prescription drugs. To keep things simple, we use
“drug” in this chapter to mean a Part D prescription drug. As explained in Chapter 5, not all drugs are
Part D drugs – some drugs are covered under Medicare Part A or Part B and other drugs are excluded
from Medicare coverage by law.
To understand the payment information we give you in this chapter, you need to know the basics of
what drugs are covered, where to fi ll your prescriptions, and what rules to follow when you get your
covered drugs. Here are materials that explain these basics:
• Th e plan’s List of Covered Drugs (Formulary). To keep things simple, we call this
the “Drug List.”
� Th is Drug List tells which drugs are covered for you.
� It also tells which of the four “cost-sharing tiers” the drug is in and whether there are any
restrictions on your coverage for the drug.
� If you need a copy of the Drug List, call Customer Service (phone numbers are printed
on the back cover of this booklet). You can also fi nd the Drug List on our website at
www.emblemhealth.com/medicare. Th e Drug List on the website is always the most
current.
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