Prescription Drug Plan Copayment Summary - Providers
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UMWA Health and Retirement Funds

Prescription Drug Plan Copayment Summary - Providers

 
1992 Benefit Plan
Copayment Year
January 1 – December 31
Copayment Per
Prescription
$5
Mail Order Prescription
Copayment
$0 per 90 day fill
Annual Prescription Copayment Family Maximum
$50
 
Alternate Program of Benefits
Copayment Year
January 1 – December 31
Copayment Per
Prescription
$25 (PPL Network)
$40 (Non-Network)
Mail Order Prescription
Copayment
$10 per 90 day fill
Annual Prescription Copayment Family Maximum
$1000 (PPL Network)
$1000 (Non-Network)
Family Out-of-Pocket Maximum
$2250 (includes Medical)
 
1993 Benefit Plan
Copayment Year
January 1 – December 31
Copayment Per
Prescription
$15 (PPL Network)
$30 (Non-Network)
Mail Order Prescription
Copayment
$5 per 90 day fill
Annual Prescription Copayment Family Maximum
$600 (PPL Network)
$600 (Non-Network)
Family Out-of-Pocket Maximum
$1600 (includes Medical)
 
Combined Benefit Fund
Copayment Year
March 27 – March 26
Copayment Per
Prescription
$5
Mail Order Prescription
Copayment
$0 per 90 day fill
Annual Prescription Copayment Family Maximum
$50
 
Prefunded Benefit Plan
Copayment Year
January 1 – December 31
Copayment Per
Prescription
$15 (PPL Network)
$30 (Non-Network)
Mail Order Prescription
Copayment
$5 per 90 day fill
Annual Prescription Copayment Family Maximum
$600 (PPL Network)
$600 (Non-Network)
Family Out-of-Pocket Maximum
$1600 (includes Medical)

 

UMWA 1993 Individual Employer Program Benefits ("Actives and Retirees")
Copayment Year
January 1 – December 31
Copayment Per
Prescription
$20 per 30-day supply
Mail Order Prescription
Copayment
$10 per 30-day supply
Annual Prescription Copayment Family Maximum
$1,000
Coverage for Preventive Therapy (ACA)
YES
​Surcharges apply for non-preferred drugs
​1st fill - $0;
2nd fill - $10;
3rd fill plus - $20 (all per 30 days)
 
UMWA 1993 Section 9711 Program and Benefits
Copayment Year
March 27 - March 26
Copayment Per
Prescription
$5 per 30-day supply
Mail Order Prescription
Copayment
$0 for up to 90 days
Annual Prescription Copayment Family Maximum
$50
Coverage for Preventive Therapy (ACA)
YES
​Surcharges apply for non-preferred drugs
​1st fill - $0;
2nd fill - $10;
3rd fill plus - $20 (all per 30 days)
 
 
Other information about above plans:
Specialty Pharmacy Medications limited to a 30-day supply
Claims will not process through a non-participating or non-preferred pharmacy. Will need to submit manual claims
Non-preferred specialty medications require