Active Health Summary Plan Description
As of September 1, 2017
En Español (PDF)

8.5 Limitations

The following items are a covered benefit subject to the limitations as stated below:

  1. Drugs for sexual dysfunction for both males and females are limited to a maximum of eight (8) pills for a 30-day supply and the co-payment will be the same as any other drug.
  2. Smoking deterrents when prescribed in writing, by a physician, subject to the following limitations: up to 90 days' supply per year; lifetime maximum benefit, 180 days' supply.

    This limitation applies to smoking deterrents received from both retail and mail pharmacy outlets. It is recommended you discuss a treatment plan with your physician. There are many products to assist you in smoking Cessation. These include the following:
    1. Nicotine Patches
    2. Nicotine Gum
    3. Nicotine Nasal Spray (Rx Required)
    4. Nicotine Inhalers (Rx Required)
    5. Nicotine Lozenges
    6. Zyban (Bupropion) (Rx Required)
  3. Morning after pills and kits (i.e., Preven, Plan B) - (limited to two (2) total per person per 365 days)