|
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Exclusions and LimitationsWhat benefits are not covered? No benefits
shall be payable under this Plan for the following:
*Generic forms of this medication are available for co-pay
option $25 to $75 Tiered Max-Pay
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Level 1 Co pay $25 Per Month |
||
|
Drug |
3 Month Supply |
3 Month Co pay |
|
AVANDAET 1mg/500mg |
100 |
$75.00 |
|
AVAPRO 75mg tablets |
90 |
$75.00 |
|
PREMARIN 0.0625MG table |
84 |
$75.00 |
|
Level 2 Co pay $40 per Month |
||
|
BENICAR 40 mg tablet |
90 |
$120.00 |
|
CELEBREX 100mg capsule |
120 |
$120.00 |
|
EFFEXORXR 37.5mg tablet |
84 |
$120.00 |
|
LEXAPRO 10mg tablet |
90 |
$120.00 |
|
NASONEXAQ NASAL SPRAY 50mcg |
120 |
$120.00 |
|
Level 3 Co pay $50 per Month |
||
|
CELEBREX 200mg capsules |
90 |
$150.00 |
|
EFFEXOR XR 75mg capsule |
84 | $150.00 |
|
EVISTA 60mg tablet |
84 | $150.00 |
|
LIPITOR 20mg tablet |
90 | $150.00 |
|
Level 4 Co pay $60 per Month |
||
|
ADVAIR DISKUS 100/50/mcg accuhaler |
90 |
$180.00 |
|
BONIVA 150mg tablet |
3 |
$180.00 |
|
CRESTOR 10mg tablet |
90 | $180.00 |
|
LEXAPRO 20mg tablet |
90 | $180.00 |
|
LIPITOR 40mg tablet |
90 | $180.00 |
|
NEXIUM 20 mg tablet |
84 | $180.00 |
|
Level 5 Co pay $75 per Month |
||
|
ACTOS 30mg tablet |
84 |
$225.00 |
|
ADVAIR DISKUS 250/50mg accuhaler |
180 | $225.00 |
|
AVANDIA 4mg tablets |
84 | $225.00 |
|
NEXIUM 40mg tablet |
84 | $225.00 |
|
SINGULAR 10mg tablet |
84 | $225.00 |
The SaveNow Rx Plan includes the following
WorldDoc benefit at no additional cost.
WorldDoc is not insurance.
WorldDoc Health
Management Systems is a new and exciting benefit which will
allow you to evaluate your health symptoms and understand your
medication and their costs.

WorldDoc offers online health decision support services that
empower people to make better health care choices. Using an
online, interactive graphical and text based system, WorldDoc
easily helps people decide what they may have and what they
should do for medical problems like cough, red eye, high blood
pressure, asthma, or knee pain. Every time you have a health
related question login with your username and password to access
these WorldDoc tools:
Personal Evaluation System - use this tool to evaluate
your symptoms, find out what conditions you might have and how
to treat them.
Health Risk Assessment - this tool helps you evaluate
your overall health and find out your risk levels for major
preventable diseases.
Medical Library - use this tool to search information
about medical conditions, tests, self-care and medical
treatments.
Health Helpers - is the place to go when you need
information on how to prevent diseases and manage long-term
chronic conditions.
Insurance Benefit Underwritten by
The insured portion of the SaveNow Rx Plan is underwritten by Companion Life Insurance Company of South Carolina

Qualifications: Membership in NationalWay Healthcare Association (NWHA) is required to receive these benefits. All costs of the association dues are included in the monthly cost of this plan.
| 2010 - SaveNow Rx Plan -
|