Page 7 - Summit LTC Management LLC_Benefit Guide_GROUP 2 2019-2020_Revised 10-1-2020

Prescription Benefits

(Included with Medical Plans 1 and 2)

The RxEDO pharmacy network includes over 68,000 total participating retail pharmacy locations nationwide; all major
chains are included as well as 20,000+ independent pharmacies.

Helpful Hints

• Please communicate to your pharmacist that your plan has changed to a new prescription drug processor.

• Show them your identification card. It includes the BIN and PCN numbers, as well as any other information they will
need to process your claim through RxEDO.

• If your pharmacy has any questions concerning the process, please have them call the RxEDO Pharmacy Help Desk at
(800) 522-7487, which is printed on your new identification card.

For questions or drug look-up go to www.rxedo.com or call 1-888-879-7336.

Discount Prescription Drug Benefit (Included with Plan 1)

Eligible medications will be available to all members at RxEDO’s pharmacy’s contracted
rate, which can typically save members anywhere from 10% - 79% off of the pharmacy’s
usual and customary fee. Standard drug inclusions and exclusions apply.
Diabetic Supplies: 10% to 60% Saving on Diabetic Supplies. A convenient service for
members with diabetes. This program provides special member pricing on most diabetic
supplies. These items include: test strips, glucose meters, lancing devices, lancets, and
MORE!

Prescription Drug Indemnity Pays (Included with Plan 2)
Your prescription drug indemnity benefit will pay a maximum amount This Applies to the Indemnity Plan
per day, per insured person, with a maximum amount per month or
calendar year depending on plan details below. There are no
copayments, deductibles, or coinsurance. • If the pharmacy’s charge is less than
the per day indemnity benefit, you will
Generic- $25 per day be mailed a check for the difference.

Brand - $50 per day • If the pharmacy’s charge is more than
the per day indemnity benefit, you will
Monthly Maximum Limit for Generic is 2 days per insured person be responsible for the difference.
Monthly Maximum Limit for Brand is 2 days per insured person • If Maximum Limit is met a Discount will
be applied.

Discount prescription drug benefits are not insurance products and are administered by RxEDO,
Inc. Prescription drug indemnity benefits are insured by Pan-American Life Insurance Company
on form number PA-IOPD-15-P and administered by RxEDO. Pan-American Life is not affiliated with RxEDO.

7