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Benefits at a Glance

 

Location:

RETAIL PHARMACY

MAIL SERVICE PHARMACY

 

 For immediate medicine needs or short-term

 medicine

 

  For maintenance or

  long-term medicine(s)

 

 

Day Supply Limit:

 

  ·  34-day supply

·           90 day supply at CVS Retail Pharmacy

        Locations

 

 

   ·         90-day supply

 

 

Cost to You:

·          $75 per person annual deductible

·           $200 per family annual deductible

            20% copay after deductible met (copay is real

         time at the retail pharmacy – no need to send

         a paper claim to CVS Caremark for in network

         claims – see note below)

·            Maximum annual out of pocket $2,000 per

         individual (medical and retail pharmacy claims

         combined)*  

·           Maximum annual out of pocket $4,000 per

         family (medical and retail pharmacy claims

         combined)*

* Once the maximum annual out of pocket is met, then a $0 copay

               No Annual deductible

·

                $15 for generic

          medications

·           $35 for Preferred brand

          medications

·           $70 for all other

          medications

 

 

 

 

 

 

Contact Caremark

 

    1.  www.caremark.com

   Caremark.com is a hassle free, round-the-clock way to order refill prescriptions, 

   check order status and get important medicine information. The website will also

   help you locate an “in network” retail pharmacy near you, check drug costs and 

   much more. 

   

    2.  Caremark Customer Care

   To speak to a representative call Caremark Customer Care toll-free at 

   1-800-966-5772

 

Getting Started with Caremark Mail

 

    1.      Have your Dr.’s office phone in a prescription by calling Caremark at 1-800-378-5697.

 

    2.      If your physician faxes a prescription to CVS Caremark, please remind them to include

          your patient information with your prescription.  Fax number 1-800-378-0323

 

    3.      Call the Caremark FastStart program at 1-800-875-0867. Our FastStart® Customer

          Care representatives make all of the arrangements.  The prescribing physician is

          contacted to write the original prescription and send it to our mail service pharmacy. 

 

4.      Send in Mail order form and prescription to the address on your mail order form (obtain forms online at Caremark.com, by calling Caremark Customer Care or your benefits office)

 

5.      You can refill prescriptions online at Caremark.com

 

Caremark Specialty Pharmacy Services

 

Caremark Specialty Pharmacy Services is now your exclusive provider for specialty pharmacy services. Certain chronic and/or genetic conditions require special pharmacy products, in the form of injected or infused medicines as well as oral medications. Caremark Specialty Pharmacy Services is a comprehensive pharmacy program that provides these products directly to covered members along with the supplies, equipment and care coordination needed.

 

Personal Attention from Experts:

  • Assistance securing coverage for new drugs and therapies, processing insurance paperwork, coordinating benefits and obtaining all necessary authorizations

  • Pharmacist-led or nurse-led CareTeam to provide customized care & support Health & Welfare

 Patient Education and Support:

  • Patient education for your specific condition: telephone training, written materials, videos, Web sites and patient support groups

  • Evaluations to assess your progress on therapy, reinforce benefits, discuss your concerns and help you achieve the best results

  • Pharmacists available 24 hours a day for emergency consultations

 Greater Convenience:

  • FAST, no-hassle and confidential delivery to the location of your choice (i.e., home, doctor’s office, vacation destination, etc.)

  • Refill reminders - Helpful calls from Caremark Specialty Pharmacy

  • Convenient enrollment through Caremark.com

 To take advantage of these great benefits provided by Caremark Specialty Pharmacy Services, please call CaremarkConnect toll-free at 1-800-237-2767.

 

Paper Claims

·         Your new benefit as of 1/1/2008 provides that you pay 20% copay at the retail in network pharmacies (after the deductible is met). This eliminates the need for you to send “in network” paper claims for reimbursement.

 

·         If you have paper claims for “out of network” (for pharmacies not in the CVS Caremark network) claims you may submit a claim form and receipts to:

CVS Caremark

PO Box 52116

Phoenix AZ 85072-2116

 

Secondary Coverage with the Sheet Metal Workers Local No. 20 Plan of Benefits

If you and your spouse are covered under different prescription drug plans or if there is a primary and secondary coverage for any other reason and you would like to submit a “secondary claim” (a claim for which primary insurance has already paid a portion) for prescriptions, please send:

 

  • the explanation of benefits from the primary insurance, or

  • a detail listing from the pharmacy showing the name of the prescription(s), amount paid by the primary insurance and the patient balance

Sheet Metal Workers will need the information noted to process your prescription claims as secondary.  For Secondary Coverage with the Sheet Metal Workers Plan of Benefits please submit this information to:

 

Sheet Metal Workers NO.20

Welfare and Benefit Fund

c/o Zenith Administrators PO Box 42489

Indianapolis , IN   46242-0489

 

Remember to enclose your name, social security number and current address.