Calculation of Earned Credits/ Reimbursement of Out-of-Pocket
Costs

Net Savings

Example

Using Your Earned Credits

Important Limitations

Claim Forms and Deadlines

Medical Expenses Reimbursable Under the Program

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     Calculation of Earned Credits/Reimbursement
of Out-of-Pocket Costs

After you or your eligible dependents use "other prescription drug coverage" to obtain prescription drugs, you should submit a Prescription Incentive Program claim form to the Fund office. Attach your pharmacy receipts for each prescription filled showing the amount of your out-of-pocket costs and information which will identify the prescription drug.

The Fund office will then take the following steps:

 
   reimburse you for your "out-of-pocket" costs for using your "other prescription drug coverage" and

 
   calculate the earned credits to be recorded to your account based on the "net savings" to the Fund, as described below.

Net Savings

The earned credits to be recorded to your account will be a percentage of the "net savings" to the Fund as a result of your use of the "other prescription drug coverage." The Fund's "net savings" is determined as follows:

1.     The amount it would have cost the Fund to provide you or your eligible dependent with that prescription drug under the Fund's plan (the Fund's cost, less the co-pay and other costs you would have incurred under the Fund's Prescription Drug Benefits), minus

2.     The amount of any "out-of-pocket" costs (co-pays, deductibles, coinsurance) that the Fund reimburses you for using your "other prescription drug coverage."

Your earned credits will be a percentage of the "net savings" to the Fund. If you obtained your prescription drug at a Preferred Pharmacy or under the Fund's mail order program, the earned credits to your account will be an amount equal to fifty percent (50%) of the "net savings" to the Fund. If you obtained the prescription drug from a Non-Preferred Pharmacy, the earned credits to your account will be an amount equal to forty percent (40%) of the "net savings" to the Fund. See the section titled "Prescription Drug Benefits" for a list of Preferred Pharmacies.