Page 7 - Revelations Group 2 - 2021 Arl. Villas2
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Prescription Benefits



          Pan American






          (Included with Pan American 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)
                                                                                This Applies to the Indemnity Plan
         Your prescription drug indemnity benefit will pay a maximum amount
         per day, per insured person, with a maximum amount per month or
         calendar year depending on plan details below. There are no                 •  If the pharmacy’s charge is less than
         copayments, deductibles, or coinsurance.                                 the per day indemnity   benefit, you will
                                                                                  be mailed a check for the difference.
          Generic- $25 per day                                                  •  If the pharmacy’s charge is more than
                                                                                  the per day indemnity benefit, you will
          Brand - $50 per day
                                                                                  be responsible for the difference.
          Monthly Maximum Limit for Generic is 2 days per insured person        •  If Maximum Limit is met a Discount will
                                                                                  be applied.
          Monthly Maximum Limit for Brand is 2 days per insured person


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