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Minimum Essential Coverage (MEC) Continued
Go Generic and Save!
Many medications are available
in both brand-name and Prescription Drug Benefits
generic versions. The US Food
and Drug Administration (FDA)
reviews all generic medications
to ensure they have the same
active ingredient, dosage form,
effectiveness and quality as Under your prescription beneit program, you can get your prescriptions illed at a
the brand-name equivalent. participating retail pharmacy or through the CVS Caremark Mail Service Pharmacy.
To save money on your
medications, always ask your To Fill Your Prescription
doctor or other prescriber to
approve a generic substitution 1. If given the choice, always ask for generics
when you get a prescription. 2. At the pharmacy, present your ID card to receive the Caremark discount
3. Obtain your prescription and pay the discounted rate directly to the pharmacy
4. File a claim form to receive your reimbursement beneit, when applicable; claim
forms can be found at www.paisc.com
You can always access the most up-to-date information on your prescription beneits
at www.caremark.com.
For information about plan member rights and responsibilities, visit the customer
care page at www.caremark.com
Minimum Essential Coverage (MEC) Disclaimers
Limited Beneit Health plan is underwritten by BCS Insurance Company. All plans administered by PAI (Planned
Administrators, Inc.)
Limited Beneit Health Plan Exclusions (BCS Insurance Company)
With respect to all of the beneits provided under the policy, no beneits will be payable as the result of any
insured’s; suicide or self-inlicted injury or sickness, pregnancy of a dependent child, participation in a riot,
rest care or rehabilitative care, felonies or illegal occupations, elective procedures, racing, intoxication, routine
examinations, war or armed conlict, voluntary abortion, psychiatric or psychological conditions, well-baby care,
experimental treatments or surgery, obesity or weight control, on-job accident or sickness, or treatment outside
of the United States. The following are not covered under the outpatient physician ofice visit and outpatient
diagnostic x-ray and laboratory indemnity beneit; in-patient treatment, routine eye and dental exams, or
itting of glasses and hearing aids. The following are not covered under the outpatient prescription drug
indemnity beneit; drugs without a prescription (except insulin), therapeutic devices or appliances, experimental
or investigational drugs, inpatient drugs, blood and blood products, contraceptive materials/medication, or
infertility medication.
Accidental Death & Dismemberment Exclusions
A loss that is directly or indirectly a result of one of the following is not a covered loss; disease or inirmity of
the mind, bacterial infections, medical or surgical treatment unless a covered loss, act of war or insurrection,
unlawful participation in a riot, felony or illegal occupation, suicide or attempted suicide, riding in or descending
from any aircraft, drug or alcohol use, injury or death caused by another person (unless an innocent
bystander).
Underwritten by BCS Insurance Company, Columbia, SC.
8
Airport Terminal Services
Go Generic and Save!
Many medications are available
in both brand-name and Prescription Drug Benefits
generic versions. The US Food
and Drug Administration (FDA)
reviews all generic medications
to ensure they have the same
active ingredient, dosage form,
effectiveness and quality as Under your prescription beneit program, you can get your prescriptions illed at a
the brand-name equivalent. participating retail pharmacy or through the CVS Caremark Mail Service Pharmacy.
To save money on your
medications, always ask your To Fill Your Prescription
doctor or other prescriber to
approve a generic substitution 1. If given the choice, always ask for generics
when you get a prescription. 2. At the pharmacy, present your ID card to receive the Caremark discount
3. Obtain your prescription and pay the discounted rate directly to the pharmacy
4. File a claim form to receive your reimbursement beneit, when applicable; claim
forms can be found at www.paisc.com
You can always access the most up-to-date information on your prescription beneits
at www.caremark.com.
For information about plan member rights and responsibilities, visit the customer
care page at www.caremark.com
Minimum Essential Coverage (MEC) Disclaimers
Limited Beneit Health plan is underwritten by BCS Insurance Company. All plans administered by PAI (Planned
Administrators, Inc.)
Limited Beneit Health Plan Exclusions (BCS Insurance Company)
With respect to all of the beneits provided under the policy, no beneits will be payable as the result of any
insured’s; suicide or self-inlicted injury or sickness, pregnancy of a dependent child, participation in a riot,
rest care or rehabilitative care, felonies or illegal occupations, elective procedures, racing, intoxication, routine
examinations, war or armed conlict, voluntary abortion, psychiatric or psychological conditions, well-baby care,
experimental treatments or surgery, obesity or weight control, on-job accident or sickness, or treatment outside
of the United States. The following are not covered under the outpatient physician ofice visit and outpatient
diagnostic x-ray and laboratory indemnity beneit; in-patient treatment, routine eye and dental exams, or
itting of glasses and hearing aids. The following are not covered under the outpatient prescription drug
indemnity beneit; drugs without a prescription (except insulin), therapeutic devices or appliances, experimental
or investigational drugs, inpatient drugs, blood and blood products, contraceptive materials/medication, or
infertility medication.
Accidental Death & Dismemberment Exclusions
A loss that is directly or indirectly a result of one of the following is not a covered loss; disease or inirmity of
the mind, bacterial infections, medical or surgical treatment unless a covered loss, act of war or insurrection,
unlawful participation in a riot, felony or illegal occupation, suicide or attempted suicide, riding in or descending
from any aircraft, drug or alcohol use, injury or death caused by another person (unless an innocent
bystander).
Underwritten by BCS Insurance Company, Columbia, SC.
8
Airport Terminal Services
