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Medical, vision & pharmacy benefits, cont.

Summary of vision benefits
UnitedHealthcare is our vision benefit provider. Vision plan benefits include
an eye exam, lenses and frames once every 12 months. Dependents under the
age of 13 have access to a broader pediatric vision benefit. See the pediatric
vision summary posted on the HR intranet.

The copay for a vision exam is $15 with in-network providers. The copay for
material is also $15 with in-network providers. The materials benefit includes
glasses or contacts lenses. The contact lens benefit includes the fitting and
purchase of one pair of contact lenses, or up to six boxes of formulary
disposable lenses.
For further description of plan coverage, please refer to the vision summary
posted on the HR intranet. Search for in-network providers at
myuhcvision.com.

Pharmacy benefits summary
Express Scripts is our pharmacy benefit provider. To receive network benefits,
you must present your Express Scripts prescription identification card at
participating pharmacies. If you use an out-of-network retail pharmacy, you
will be required to pay the entire cost of the drug and file a claim for
reimbursement (copayment and coinsurance apply).

How to fill prescriptions for maintenance medications
You have two options to fill your prescriptions for maintenance medications
under our copayment plan: through Express Scripts mail order or at Walgreens
through Express Scripts Smart90 Rx program. Maintenance medications are
long-term medications you take regularly. Examples include medications for
high blood pressure, cholesterol, allergies, birth control, and diabetic supplies.
To determine if your prescription is considered maintenance medication,
contact Express Scripts. You can also view this information on
Express-Scripts.com.

If you fill your maintenance medications for a three-month supply (90 days) at
Walgreens, you will pay the same copayment as the mail order program. If you
fill your maintenance medication at a different pharmacy, or for a different
quantity, you will be charged 100% of the cost for the medication.

How to fill prescriptions that are not maintenance medications
You can fill prescriptions that are not maintenance medications at any retail
pharmacy or through Express Scripts mail order program. If you fill your
prescription at an in-network pharmacy, you will be charged the normal retail
pharmacy copayment. If your prescription is for a three-month supply and
you fill it through the mail order program, you will be charged the mail
order copayment.
Mail order prescriptions
The mail order program is another option for filling your maintenance
prescriptions. The program will provide a 90-day supply of the prescribed
medication and mails it to your home address.

6 Employee Benefits Guide