Prescription Drug Plan Copayment Summary - Providers
Skip Ribbon Commands
Skip to main content
Navigate Up
Sign In

UMWA Health and Retirement Funds

Prescription Drug Plan Copayment Summary - Providers

 

Copay Summary


Plan

Copayment Year

Retail PPL* (In-Network)/non-PPL (Out of Network) Copay

(Per 30-day supply)

Mail Copay

(Per 90-day supply)

Non-Preferred Drug Surcharge (Per 30-day Supply)

UMWA Combined Benefit Fund

March 27 – March 26

$5/$5**

$0

No

UMWA 1992 Benefit Plan

Jan 1 – Dec 31

$5/$5**

$0

No

1993 Plan Traditional Program of Benefits

Jan 1 – Dec 31

$15/$30

$5

No

1993 Plan Alternate Program of Benefits

Jan 1 – Dec 31

$25/$40

$10

No

1993 Plan Post-Legislative Program of Benefits

Jan 1 – Dec 31

$15/$30

$5

No

1993 Plan Individual Employer Program of Benefits (Eligible Active Employees and Non-Coal Act Retirees of Murray American Energy, Inc. and its related entities)

Jan 1 – Dec 31

$20/$35

$30

1st fill - $0

1st refill - $10 (plus copay)

Additional refills - $20 (plus copay)

1993 Plan Section 9711 Program and Benefits (Eligible Coal Act Retirees of Murray American Energy, Inc. and its related entities)

Jan 1 – Dec 31

$5/$5**

$0

1st fill – 0

1st refill - $10 (plus copay)

Additional refills - $20 (plus copay)

 

1993 Plan UMWA Program of Benefits (Eligible Employees and Retirees of UMWA)

Jan 1 – Dec 31

$20/$35 ****

$30

1st fill - $0

1st refill - $10 (plus copay)

Additional refills - $20 (plus copay)

1993 Plan Individual Employer Program of Benefits (Murray Oak Grove Coal, LLC)

Jan 1 – Dec 31

$5/$10**

$0

1st fill - $0

1st refill - $7.50 (plus copay)

Additional refills - $15 (plus copay)

UMWA Prefunded Benefit Plan—Carbontronics

Jan 1 – Dec 31

$15/$30

$5

No

UMWA Prefunded Benefit Plan–Eligible Coal Act Retirees of Energy West Mining Company

Jan 1 – Dec 31

$5/$5**

$0

No

UMWA Prefunded Benefit Plan–Eligible Non-Coal Act Retirees of Energy West Mining Company

Jan 1 – Dec 31

$15/$30***

$5

No

*PPL – Participating Provider Lists

**Maintenance Choice Program – If a 90-day supply is obtained at a CVS retail pharmacy - $0 copay per 90-day supply

***Maintenance Choice Program – If a 90-day supply is obtained at a CVS retail pharmacy - $5 copay per 90-day supply

****Maintenance Choice Program – If a 90-day supply is obtained at a CVS retail pharmacy - $30 copay per 90-day supply

 

 

Other information about above plans:

Specialty Pharmacy Medications are limited to a 30-day supply.

Beneficiaries will need to submit a manual claim; higher copayments may apply. 

Non-preferred specialty medications require medical necessity approval and evidence of failure with preferred drugs before coverage is allowed.

 

 

 

 

​​​​​​