This service provides additional savings to the Participant and to the Fund. If You have a chronic condition (long term illness) and require the same medication for a long time (e.g., diabetic pills, heart condition pills, etc.) You can obtain up to a 90 day supply of medication at one time through the following procedure:

You must use the special envelope and forms supplied, and Your doctor must indicate the dosage and the number of months to be used (maximum 90 days). You will pay a 20% coinsurance per prescription toward the cost of Your prescription drugs if generic drugs are prescribed. If nongeneric drugs are prescribed, You will pay the 20% coinsurance plus the difference between the cost of the non-generic drug and the generic drug if a generic drug is available. You should then mail Your prescription to:

ExpressScripts
P.O. Box 747000
Cincinnati, OH 45274-7000

Your medicine will be delivered to You by mail or United Parcel Service at no further cost whatsoever. You should allow at least 10 days turn around time for the delivery of Your letter and the return to You of the medication. Do not leave Yourself without an adequate supply of medication during this period.

LIMITATIONS (RETAIL)

Prescriptions may not exceed a 34 day supply. You are entitled to two (2) maintenance medications at retail. On the third fill you will be charged a 40% copay instead of 20% unless you use Express Scripts By Mail.

The second time you purchase certain long-term drugs (such as those used to treat high blood pressure or high cholesterol) at a participating retail pharmacy, you will pay your retail copayment. After that, you will pay an additional 20% higher copay for these long-term drugs unless you choose to order them through Express Scripts By Mail. You should continue to purchase short-term drugs such as antibiotics at a participating retail pharmacy. You’ll still pay your participating retail pharmacy co-payment for short-term drugs.

EXCLUSIONS

The following are exclusions from coverage unless specifically listed as a benefit:

• Contraceptives, oral or other, whether medication or devices, regardless of intended use.
• Therapeutic devices or appliances, including all needles and syringes, support garments, and other non-medical substances, regardless of intended use, except for diabetic supplies.
• Prescriptions for which an eligible person is entitled to receive without charge due to Workers’ Compensation law, or any municipal, state or federal program. Drugs labeled “Caution-limited by federal law to investigational use,” or experimental drugs, even though a charge is made to the individual.
• Medication which is to be taken by or administered to an individual, in whole or in part, while he or she is a patient in a licensed hospital, rest home, sanitarium, extended care facility, convalescent hospital, nursing home or similar institution which operates on its premises, or allows to be operated on its premises, a facility for dispensing pharmaceuticals.
• Any prescription filled in excess of the number specified by the physician, or any refill dispensed after one year from the physician’s original order.

If you have any questions or need assistance, please call Member Services toll free at 1-800-251-7689. Express Scripts is there for you around the clock (except Thanksgiving and Christmas).

You can also view Plan information and compare prices online: Register at www.ExpressScripts.com to quickly refill your mail-order prescriptions, locate participating retail pharmacies, and use My Rx Choices to view potential lower-cost options, such as generics, for your longterm medications. Express Scripts, with your approval, will contact your doctor to arrange for you to get a new prescription for the lower cost option you select.