Retiree Health Plan Benefit Tabs™

This is a summary of benefits and not a substitute for the Southern California IBEW-NECA Retiree Health Plan Summary Plan Description, and to the extent it differs from the SPD, the terms of the SPD will govern.


Prescription Plan
 

Participants who elect Kaiser Senior Advantage receive their prescription drug benefit through Kaiser Permanente. A brief description of the prescription drug benefit is described in the Kaiser BenefitTab.

Participants who elect UnitedHealthcare® Group Medicare Advantage receive their prescription drug benefit through UnitedHealthcare® Group Medicare Advantage Prescription Drug Program. A brief description of the prescription drug benefit is described in the UnitedHealthcare BenefitTab.

Participants who elect the Out of Area Plan receive their prescription drug benefit through the Out of Area - UnitedHealthcare® Group Medicare Advantage Prescription Drug Program. A brief description of the prescription drug benefit is described in the Out of Area BenefitTab.

Early Retirees and Participants who elect Medicare Supplement receive their prescription drug benefit through the Mandatory Generic Prescription Drug Plan currently administered by CitizensRx. The Mandatory Generic Prescription Drug Plan is designed to help you meet the cost of prescription drugs prescribed by your doctor, for you or your eligible spouse, for the treatment of illness or injury. The pharmacist will dispense a generic drug substitute whenever it is available. If you choose to obtain a brand name drug instead of a generic, you may do so, but it will result in greater expense for you.

Walk-in Pharmacy Benefits
 
Category Your Copay
Generic - 30 day supply
$0
Generic ( 100 day supply - maintenance) $0
Brand-name - 30 day supply (when generic not available) $10
Brand-name (100 day supply- maintenance - when generic not available) $20
Mail Service Pharmacy Benefits for Maintenance Drugs
 
Category Your Copay
Generic - 100 day supply $0
Brand-name 100 day supply (when generic not available) $20
Non-Network Pharmacy Benefits
 

You are encouraged to use network pharmacies or the Citizens Rx Home Delivery service to fill your prescriptions. However, the Retiree Health Plan will reimburse you a limited amount for a prescription filled at a non-network pharmacy. This policy is intended for emergency purposes (e.g. traveling away from home). You may obtain up to a 30-day supply.

Non-network pharmacy claim forms are available from the Administrative Office or here. You will fill out one portion of the claim form. The pharmacy must fill out the rest of the form.

Category Your Copay
Generic - 30 day supply $5
Brand-name 30 day supply (when no generic available) $15
Partial List of California Network Pharmacy Chains
 

For an up-to-date list of nationwide pharmacies, go to www.citizensrx.com or call (888) 545-1120.

  • Albertsons
  • Costco
  • CVS (including Target Pharmacy and Longs)
  • Horton and Converse
  • K-Mart Pharmacies
  • Medicine Shoppe
  • Pavilions Pharmacies
  • Raley's Super Stores
  • Ralphs
  • Rite Aid
  • Safeway Pharmacy
  • Save Mart Supermarkets
  • Sav-On Pharmacy Drugs
  • Shopko Stores
  • Vons/Pavilions Pharmacies
  • Walgreens
Limitations
 

Certain limitations apply to the following covered benefits: smoking deterrents, morning after pills & kits, and drugs to treat erectile dysfunction. Click here to learn more about limitations.

Additional Information
 

Citizens Rx
Website: http://www.citizensrx.com/member/