TABLE OF CONTENTS

INTRODUCTION

EMPLOYEE PRESCRIPTION DRUG PLAN

ELIGIBILITY

PLAN BENEFITS

Retail Pharmacy

Mail Order Service

Specialty Pharmaceutical Provider

Copayment Amounts

PURCHASING YOUR PRESCRIPTION DRUGS AT A PHARMACY

Participating Pharmacies

Non-Participating Pharmacies

How to File a Claim for Reimbursement

MAIL ORDER SERVICES

How the Mail Order Service Works

Transfer an Existing Prescription

New Prescriptions Submitted by Phone from your Doctor

New Prescriptions Submitted by Phone from the Member

Online Access

Obtaining Refills Through the Mail Order Service

INFORMATION ABOUT GENERIC DRUGS

What are Generic Drugs?

Who Determines if a Participant can Receive Generic Drugs?

COVERAGE AND SERVICES PROVIDED BY THE EMPLOYEE PRESCRIPTION DRUG PLAN

Dispensing Limits

Utilization Management

WHAT THE EMPLOYEE PRESCRIPTION DRUG PLAN DOES NOT COVER

ENROLLING IN THE EMPLOYEE PRESCRIPTION DRUG PLAN

Levels of Coverage

When Coverage Begins

Transfer of Employment

Leave of Absence

When Coverage Ends           

COBRA COVERAGE

COBRA Events

Duration of COBRA Coverage

Termination of COBRA Coverage

Employer Responsibilities Under COBRA

Employee Responsibilities Under COBRA

Failure to Elect COBRA Coverage

Additional Information About COBRA

APPENDIX I

CLAIM APPEAL PROCEDURES

THIRD TIER COPAYMENT EXCEPTION

HIPAA PRIVACY

AUDIT OF DEPENDENT COVERAGE

APPENDIX II

GLOSSARY

APPENDIX III

NOTICE OF PRIVACY PRACTICES

APPENDIX IV

SHBP CONTACT INFORMATION

SHBP PUBLICATIONS

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