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CHIP II Prescription Coverage


Outpatient prescription drugs are covered under the CHIP II plan as part of the overall comprehensive medical plan. The CHIP II plan covers outpatient medications routinely prescribed for common acute and chronic conditions. The plan's $1,200 deductible, 10 percent co-insurance, and $4,200 single/$8,400 family out-of-pocket maximum (OPM) applies to the cost of prescriptions. Once the OPM has been met, the plan pays 100% of the expenses incurred for drugs during the rest of the calendar year.

The pharmacy is not responsible for submitting your prescription claims. You will pay for the prescription upon receipt and submit the necessary documents to Blue Cross/Blue Shield for reimbursement if your pharmacy does not electronically submit the claims.

Services Covered by the Prescription Drug Plan

  • Prescription drugs (unless specifically excluded)
  • Prenatal vitamins
  • Prescription contraceptives and devices
  • Prescription smoking cessation drugs
  • Prescription drugs used as part of home health care services
  • Insulin
  • Disposable syringes and needles for the injection of insulin
  • Glucose monitoring strips/lancets

Services Not Covered by the Prescription Drug Plan

  • Prescription drugs received from a non-Blue RX pharmacy, except in an emergency or when temporarily living out of Iowa
  • Most over-the-counter drugs
  • Therapeutic devices and appliances, except disposable syringes and needles for the injection of insulin
  • Nutritional supplements, including vitamins (except for prenatal vitamins)
  • Investigational drugs labeled "Caution: Limited by Federal Law to Investigational use"
  • Drugs not medically necessary for the treatment or prevention of illness, injury, or other covered condition
  • Drugs used for cosmetic purposes (e.g., tretinoin (Retin-A) for treatment of skin aging, minoxidil (Rogaine) for stimulation of hair growth)
  • Drugs dispensed by a person authorized to prescribe drugs (e.g., physicians, dentists and advanced registered nurse practitioners.)
  • Drugs obtained outside the United States
  • Charges for drugs covered by Worker's Compensation laws or other federal, state, or county programs

 

Last modification date: Mon Oct 15 16:29:52 2007
URL: http://www.uihealthcare.com /depts/uihealthplans/rxchip.html