Rx Copay Summary
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UMWA Health and Retirement Funds

Rx Copay Summary

The amount you will need to pay for prescription drugs depends on the Funds Plan in which you are enrolled. The copayment year, the copayment amount and the maximum out-of-pocket amount is different for each Plan listed below. If you have any questions, please call the Call Center at 1-800-291-1425, option 2.

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 medical necessity approval and evidence of failure with preferred drugs before coverage is allowed