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K E Y A D VA N TA G E1000B EN EFITS S UMM A RYEffective July 1, 2016 or October 1, 2016BENEFIT HIGHLIGHTSThe TLC Key Advantage Member Handbook and thisKey Advantage 1000 Benefits Summary constitutea complete description of the benefits, exclusions,limitations, and reductions under the plan.How The Plan Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Benefits At-A-Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4An electronic version of the handbook is availableonline at www.thelocalchoice.virginia.gov and atwww.anthem.com/tlc.Take Care Package . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Routine Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8If You Need Assistance . . . . . . . . . . . . . . . . . . . Back Cover
K E Y A DVA NTAG E1000WHO IS ELIGIBLEn Active Employees and their Dependentsn R etirees not eligible for Medicare and theirDependents not eligible for Medicare, and/orn D ependents of Medicare eligible Retirees who arenot Medicare eligible.NOTE: Medicare eligible retirees and the Medicare eligible dependents of anyretiree (Medicare eligible or otherwise), may not enroll in Key Advantage 1000.If your Local Employer offers a TLC Medicare supplemental plan, be aware thatparticipation in both Parts A and B of Medicare is required to receive maximumbenefits under the Medicare supplemental plan. Part D expenses are not covered.PL AN YE ARYour benefits are administered on a plan year basis which is July 1 throughJune 30, or October 1 through September 30, depending upon yourrenewal date.SERVICE ARE AThis plan is available wherever employees and eligible retirees live or work. THIS IS A SUMMARY of your medical, vision, behavioral health andemployee assistance (EAP), prescription drug, and dental benefits. Yourbenefits are administered by Anthem Blue Cross and Blue Shield, withthe exception of your dental benefits. Under a separate agreement withAnthem, Delta Dental of Virginia will administer routine dental benefits.
HOW THE PL AN WORKSYOUR MEDIC AL ANDBEHAVIOR AL HE ALTH NET WORKSMedical BenefitsOut-of-Network CareMedical care is provided by primary care physicians (generalor family practitioner, internist or pediatrician), specialty careproviders and facilities. Referrals are not needed. Highercopayments apply for specialist and facility visits.You may receive care outside these networks. However,you have a separate plan year out-of-network deductibleand out-of-pocket expense limit. Once you have met theout-of-network deductible, you pay 30% coinsurance forall covered medical and behavioral health services. Claimspayments are made directly to the member, rather than tothe provider. See page 2 for more information about howyour out-of-pocket expense limit works both in and out ofthe network.Behavioral Health and EmployeeAssistance Program (EAP) BenefitsAnthem behavioral health associatesare available to assist you in locatinga behavioral health provider in yournetwork. You also may locate a behavioralhealth network provider on the Web atwww.anthem.com/tlc, and click on Find a Doctor.You are encouraged to have all behavioral health servicespre-authorized by calling 1-855-223-9277 before receivingcare, or within 48 hours of an emergency admission.Anthem Behavioral Healthcare case managers certify theappropriate levels of mental health and substance abusecare based on your diagnosis and medical necessity criteria.The EAP provides up to four counseling sessions perissue free of charge to you and your household members.Contact Anthem EAP toll-free at 1-855-223-9277 formore information.In-Network CareYour networks are the Anthem PPO networkin Virginia and the BlueCard PPO andBlueCard Worldwide networks outsideVirginia. Referrals for care are not required.Care When TravelingIf you live or travel outside of Virginia, you will receive thehighest level of medical benefits when you receive carefrom a BlueCard PPO provider in that area. Providers whoparticipate with other Blue Cross Blue Shield companieswill accept your copayment or coinsurance at the time ofservice instead of requiring full payment. These providers orfacilities will file claims directly to their local Blue Cross BlueShield company for you, and have agreed to accept theallowable charge established with their local Blue Cross BlueShield company as payment in full for their services.BlueCard Worldwide gives you access to doctors andhospitals for medical care in more than 200 countries andterritories around the world.Call 1-800-810-BLUE (2583) to locate a BlueCard PPOor BlueCard Worldwide provider. Be sure to present yourTLC/Anthem identification card when you receive careoutside Virginia. The suitcase emblem at the top of yourcard indicates that your plan includes the BlueCard program.For the most current list of Anthem PPO network providersgo to www.anthem.com/tlc and click on Find a Doctor.K E Y A DVA N TAG E 1 0 0 01
Medical Out-of-Pocket Expense LimitPRESCRIPTION DRUGSThere are separate medical and behavioral health out-ofpocket expense limits for in-network and out-of-networkservices. There is no out-of-pocket expense limit for dentalservices.Retail PharmacyIn-Network ServicesYou’ll get the most from your drug programby using network pharmacies. Simplyshow your ID card and pay the appropriatecopayment. Your network has more than64,000 pharmacies across the country – including mostchains and some local, independent pharmacies. Checkwith your pharmacy to be sure they participate, or call us at1-800-552-2682. If you are the only one covered by the plan, the mostyou will pay out of your pocket is 5,000 per plan year forcovered services. Once you have reached this amount,your payment for covered in-network services is 0. If two or more people are covered by the plan, themost all of you will pay out of your pocket is 10,000.However, no family member will pay more than 5,000toward the limit. Then your payments for coveredin-network services are 0.Out-of-Network Services If you are the only one covered by the plan, the mostyou will pay out of your pocket is 9,000 per planyear for covered services. Once you have reachedthis amount, your payment for covered services is 0.However, out-of-network providers may bill youfor amounts above the plan’s allowable charge, andpayment is your responsibility. If two or more people are covered by the plan, themost all of you will pay out of your pocket is 18,000.However, no family member will pay more than 9,000toward the limit. Then your payments for coveredservices are 0. However, out-of-network providers maybill you for amounts above the plan’s allowable charge,and payment is your responsibility. he following do not count toward the out-of pocketTexpense limit, and you are responsible for payingthese costs when the out-of-pocket expense limit hasbeen reached: Dental services Cost of care in excess of benefit limitsThis is a mandatory generic program for up to a 34-daysupply of covered drugs at a retail pharmacy.If you choose a pharmacy out of the network, you’ll need topay the total cost of the drug when you pick it up, and thenfile a Prescription Drug Claim Form to get reimbursed. Youmay be responsible for the difference between the pharmacy’scharge and the plan’s allowable charge for the drug.Q. Can I get a 90-day supply of my drug at a networkretail pharmacy?Yes. You’ll pay three copayments for the drug. Keep inmind that you pay only two copayments for a 90-daysupply when you use the home delivery pharmacy.Q. Can I get a brand name drug instead of a generic?You have a mandatory generic drug program. However, ifthere is no generic equivalent for the drug, you may get thebrand and pay only the applicable copayment. If there is ageneric equivalent available, you may opt to use the brand,but you’ll pay the brand copayment plus the differencebetween the brand and generic allowable charge.Q. What if I need more than a 34-day supply becauseI’m travelling out of the country and won’t haveaccess to a participating pharmacy?You can submit the Prescription Drug Refill ExceptionRequest form to the Department of Human ResourceManagement (DHRM). It’s available atanthem.com/tlc under Forms. Cost of services and supplies not covered under the plan Additional amount non-network providers may bill youwhen their charge is more than the plan’s allowable charge2K E Y A DVA N TAG E 1 0 0 0 Home Delivery PharmacySwitching to home delivery is simple. You can place yourfirst order by phone or online at anthem.com.
By phone: Call 800-355-8279. A representative will helpyou with your order. Have your prescription, doctor’s name,phone number, drug name and strength, and credit cardhandy when you call.Online: Login to anthem.com and select Pharmacy underthe Benefits tab. Follow the steps under Pharmacy Self Serviceto request a new prescription or refill a current prescription.You pay only two copayments for a three-month supplyof drugs when you use the Home Delivery service, and themedication is delivered right to your home.Specialty PharmacySpecialty Home DeliveryYour pharmacy program includes access to Accredo, apharmacy dedicated to providing members with specialtydrugs. Specialty medications include biopharmaceuticaland injectable drugs. Accredo is also a complete supportprogram with clinicians and personal care coordinatorsto help members taking specialty drugs achieve the bestpossible outcomes from their treatments.Contact Accredo at 1-877-886-1705 to begin using theSpecialty Home Delivery service. Provide them with yourdoctor’s name and phone number, and they’ll do all the rest.Specialty RetailYou can also obtain your specialty drugs from a participatingretail pharmacy for up to a 34-day supply, or pay threecopayments for a 90-day supply. R OUTINE VISIONBENEFITSYour routine vision benefits are availablefrom Blue View VisionSM once everyplan year. You may have your eye examand purchase lenses and frames fromany Blue View participating optician,optometrist or retail setting, including 1-800 CONTACTS,LensCrafters , Target Optical, Sears OpticalSM, andJCPenney Optical. If you receive your eye exam, eyeglassframes or lenses from a non-Blue View provider, the nonBlue View network benefits will apply. Please see page 8 formore details on your routine vision benefits.Go to www.anthem.com/tlc and click on Find a Doctorto find a Blue View provider near you.Note: If you need medical, non-routine treatment for youreyes, consult your physician or an Anthem PPO networkeye specialist.DENTAL(administered by Delta Dental)You have two choices for your dental benefits. TheComprehensive dental option is included in your plan andincludes Preventive, Primary, Major and Orthodontic dentalservices. The Preventive option includesonly the twice per plan year routine oralexam, cleaning, x-rays, sealants and fluoridefor children. This option is available for alower premium, and you must choose it bycompleting an enrollment form.To reduce your out-of-pocket expense, choose a DeltaDental network dentist. View the Delta PPO and Premiernetworks of dentists at www.deltadentalva.com. Claimswill be handled by the dentist’s office and you will beresponsible only for the dental deductible and coinsurancethat applies to the covered care you receive. If you go toa non-network dentist, you pay the dental deductible andcoinsurance plus any amount above the allowable chargethat the dentist may bill you.When you anticipate dental charges over 250,have your Delta Dental dentist file a pre-determination(pre-treatment) estimate.Get the details at www.deltadentalva.com. Click onThe Local Choice from the home page. View your benefits booklet Find a dentist Check claims Learn about good oral healthK E Y A DVA N TAG E 1 0 0 03
B E N E F IT S AT-A- G L A N C EIN-NET WORKOUT- OF-NET WORKOne Person 1,000 2,000Family (two or more people) 2,000 4,000PL AN YEAR OUT- OF-POCKETEXPENSE LIMITOne Person 5,000 9,000Family (two or more people) 10,000 18,000OUT- OF-NET WORK BENEFITSYes. Once you meet the out-of-network deductible, you pay 30% coinsurancefor medical and behavioral health services. Copayments do not apply to out-ofnetwork medical and behavioral health services. Copayments and coinsurance forroutine vision, outpatient prescription drugs and dental services will still apply.MEDIC AL AND BEHAVIOR ALHEALTH C ARE WHEN TR AVELINGThe BlueCard PPO and BlueCard Worldwide programs are included formedical and behavioral health care outside Virginia.LIFETIME MA XIMUMUnlimitedBENEFITPL AN YEAR DEDUCTIBLE(applies as indicated)COVERED SERVICESAMBUL ANCE TR AVELNo Plan Year limitAUTISM SPECTRUM DISORDER2 years through 10 yearsYOU PAYIN-NET WORK20% coinsurance, after deductibleCopayment/coinsurance determined by service receivedBEHAVIOR AL HEALTHINPATIENT TREATMENT20% coinsurance, after deductibleRESIDENTIAL TREATMENT20% coinsurance, after deductiblePARTIAL HOSPITALIZ ATION (DAY) PROGR AM20% coinsurance, after deductibleINTENSIVE OUTPATIENTTREATMENT PROGR AM (IOP)20% coinsurance, after deductibleOUTPATIENT TREATMENT PROGR AMFacility Services20% coinsurance, after deductibleProfessional Provider Services 25 copaymentCHIROPR ACTIC , SPINAL MANIPUL ATIONS ANDOTHER MANUAL MEDIC AL INTERVENTIONS30-Visit Plan Year limit per memberPrimary Care Physicians 25 copaymentSpecialty Care Providers 40 copaymentDENTAL C AREPREVENTIVE DENTAL OPTION(diagnostic and preventive services only for lower premium) 0COMPREHENSIVE DENTAL OPTION(for higher premium)Dental Plan Year DeductiblePlan Year Maximum (Except Orthodontics)4One Person 25Two People 50Family 75 1,500Preventive Dental Care 0Primary Dental CareMajor Dental CareOrthodontic Services (Includes Adult Ortho)20% coinsurance after dental deductible50% coinsurance after dental deductible50% coinsurance, no dental deductible, with 1,500 lifetimemaximumK E Y A DVA N TAG E 1 0 0 0
COVERED SERVICESYOU PAYIN-NET WORKDENTAL SERVICES (NON-ROUTINE MEDIC AL)20% coinsurance, after deductibleDIABETIC EDUC ATION 0DIABETIC EQUIPMENT20% coinsurance, after deductibleDIAGNOSTIC TESTS, L ABS AND X-R AYSOutpatient SurgeryOutpatient Diagnostic Services OnlyOutpatient Emergency Room20% coinsurance, after deductible20% coinsurance, after deductible20% coinsurance, after deductibleDIALYSIS TREATMENTSFacility ServicesDoctor’s Office 0 0DOCTOR’S VISITS (On an Outpatient basis)Primary Care PhysiciansSpecialty Care ProvidersEMPLOYEE A SSISTANCE PROGR AM (EAP)Up to four Visits per issue (per plan year)EARLY INTERVENTION SERVICES(Birth to 3 years) 25 copayment 40 copayment 0Copayment/coinsurance determined by service receivedEMERGENCY ROOM VISITSFacility ServicesProfessional Provider ServicesPrimary Care PhysiciansSpecialty Care ProvidersDiagnostic Tests, Labs and X-raysHOME HEALTH SERVICES90-Visit Plan Year limit per memberHOME PRIVATE DUT Y NURSE’S SERVICESHOSPICE C ARE SERVICES20% coinsurance, after deductible 25 copayment 40 copayment20% coinsurance, after deductible 020% coinsurance, after deductible 0HOSPITAL SERVICESINPATIENT C AREFacility ServicesProfessional Provider ServicesPrimary Care PhysiciansSpecialty Care ProvidersDiagnostic Services20% coinsurance, after deductible 0 0 0OUTPATIENT C AREFacility ServicesProfessional Provider ServicesPrimary Care PhysiciansSpecialty Care Providers20% coinsurance, after deductible 25 copayment 40 copaymentK E Y A DVA N TAG E 1 0 0 05
COVERED SERVICESDiagnostic Tests, Labs and X-raysYOU PAYIN-NET WORK20% coinsurance, after deductibleMATERNIT YProfessional Provider ServicesPrenatal and Postnatal CarePrimary Care PhysiciansSpecialty Care ProvidersDeliveryPrimary Care PhysiciansSpecialty Care ProvidersHOSPITAL SERVICES FOR DELIVERY 25 copayment 40 copayment 0 0Delivery room, anesthesia, routine nursing carefor newborn20% coinsurance, after deductibleDIAGNOSTIC TESTS, L ABS AND X-R AYS20% coinsurance, after deductibleMEDIC AL EQUIPMENT (DUR ABLE),APPLIANCES, FORMUL A S, PROSTHETICS ANDSUPPLIES20% coinsurance, after deductibleOUTPATIENT PRESCRIPTION DRUGS(mandatory generic)RETAIL PHARMACYCovered drugs per 34-day supplyTier 1 10 copaymentTier 2 30 copaymentTier 3 45 copaymentTier 4 55 copaymentHOME DELIVERY SERVICES (MAIL ORDER)Covered drugs for up to a 90-day supplyTier 1 20 copaymentTier 2 60 copaymentTier 3 90 copaymentTier 4 110 copaymentDIABETIC SUPPLIESSHOTS – ALLERGY & THER APEUTIC INJECTIONSAt a doctor’s office, Emergency room orOutpatient hospital department20% coinsurance, no deductible20% coinsurance, after deductibleSKILLED NURSING FACILIT Y STAYS180-day per Stay limit per member1Facility Services 01 A stay is the period from the admission to the date of discharge from a Facility. If there is less than a 90 day break between two admissions, the days allowable for the subsequent admissionare reduced by the days used in the first. If there are more than 90 days between the two admissions, the days available for the subsequent admission start over for a full 180 days.6K E Y A DVA N TAG E 1 0 0 0
COVERED SERVICESProfessional Provider ServicesYOU PAYIN-NET WORK 0SURGERYINPATIENTFacility Services20% coinsurance, after deductibleProfessional Provider ServicesPrimary Care Physicians 0Specialty Care Providers 0Diagnostic Services 0OUTPATIENTFacility Services20% coinsurance, after deductibleProfessional Provider ServicesPrimary Care Physicians 25 copaymentSpecialty Care Providers 40 copaymentTHER APY – OUTPATIENT SERVICESC ARDIAC REHABILITATION THER APY20% coinsurance, after deductibleCHEMOTHER APY20% coinsurance, after deductibleINFUSION (includes IV therapy and injected chemotherapy)20% coinsurance, after deductibleOCCUPATIONAL THER APY20% coinsurance, after deductiblePHYSIC AL THER APY20% coinsurance, after deductibleR ADIATION THER APY20% coinsurance, after deductibleRESPIR ATORY THER APY20% coinsurance, after deductibleSPEECH THER APY20% coinsurance, after deductibleVISION CORRECTIONAfter surgery or accident20% coinsurance, after deductibleWELLNESS AND PREVENTIVE C ARE SERVICESWELL CHILD 2(Birth to 18 years)Office Visits at specified intervalsPrimary Care PhysiciansNo copayment, coinsurance, or deductibleSpecialty Care ProvidersNo copayment, coinsurance, or deductibleImmunizationsPrimary Care PhysiciansNo copayment, coinsurance, or deductibleSpecialty Care ProvidersNo copayment, coinsurance, or deductibleScreening TestsNo copayment, coinsurance, or deductibleROUTINE WELLNESS(18 years and older)Check-up Visit (one per Plan Year)Primary Care PhysiciansNo copayment, coinsurance, or deductibleSpecialty Care ProvidersNo copayment, coinsurance, or deductibleImmunizationsPrimary Care PhysiciansNo copayment, coinsurance, or deductibleSpecialty Care ProvidersNo copayment, coinsurance, or deductible2See member handbook for immunization schedule.K E Y A DVA N TAG E 1 0 0 07
YOU PAYIN-NET WORKCOVERED SERVICESRoutine Lab and X-ray ServicesNo copayment, coinsurance, or deductibleWELLNESS AND PREVENTIVE C ARE SERVICES(one of each per Plan Year)Gynecological ExamPrimary Care PhysiciansNo copayment, coinsurance, or deductibleSpecialty Care ProvidersNo copayment, coinsurance, or deductiblePap TestNo copayment, coinsurance, or deductibleMammography ScreeningNo copayment, coinsurance, or deductibleProstate Exam (digital rectal exam)Primary Care PhysiciansNo copayment, coinsurance, or deductibleSpecialty Care ProvidersNo copayment, coinsurance, or deductibleProstate Specific Antigen TestNo copayment, coinsurance, or deductibleColorectal Cancer ScreeningsNo copayment, coinsurance, or deductibleROUTINE VISION – BLUE VIEW VISION NET WORKYou have an allowance for eyeglass lenses or contact lenses every plan year. You pay the remaining cost for frames and lensesafter Your Health Plan’s Reimbursement.NetworkCovered ServicesBlue View Vision Networkn Routine eye examRoutine VisionYou pay 40 copaymentn Eyeglass lensesBlue View Vision NetworkYou pay 20 copayment(once per plan year)n Eyeglass framesPlan pays up to 100* retail allowancen Contact lenses(in lieu of eyeglass lenses) Elective1Plan pays up to 100 allowancethen 15% discount off remainingbalance Non-Elective1Plan pays up to 250 allowancen Lens options UV coating, tints,standard scratch-resistant You pay 15 Standard polycarbonateYou pay 40 Standard progressiveYou pay 65(in addition to bifocalcopayment) Standard anti-reflectiveYou pay 45 Other add-onsYou pay 20% off retailNon-Blue ViewPlan pays up to to 50Plan pays up to: 50 single lenses; 75 bifocal; 100 trifocalPlan pays up to 80Plan pays up to 80Plan pays up to 210Not availableNot availableNot availableNot availableNot available* You may select a frame greater than the covered allowance and receive a 20% discount for any additional cost over the allowance.1 Elective contact lenses are typically elected in lieu of eyeglass lenses. Non-Elective contact lenses are medically necessary contacts when glasses are not an option for vision correction,such as after cataract surgery.8K E Y A DVA N TAG E 1 0 0 0
YOUR TLC TAKE CARE PACKAGEWellness programs and Web tools included in your planEmployee Assistance Program (EAP) 855-223-9277Your EAP includes up to 4 free confidential counseling sessions per issue for you, your covered dependents and members of yourhousehold. It’s also a valuable source for information about emotional well-being, childcare and elder care resources, financial andissues, and more. Tap into all your EAP has to offer at anthem.com/tlc. Choose the EAP link, enter Commonwealth of Virginia asyour company, and select The Local Choice.24/7 NurseLine & Audio Health Tape Library 800-337-4770Sometimes you need health questions answered right away – even in the middle of the night. Call 24/7 NurseLine to speakwith a nurse. Or use the Audio Health Library if you want to learn about a health topic on your own. Your call is always free andcompletely confidential.LiveHealthOnline.comNo time to wait for an appointment? No problem. See a doctor 24/7 from your computer or mobile device. All you need is theLiveHealth Online app or a computer with a webcam to see a doctor from your home, the office, or anywhere. Enroll now so you’llbe ready to use LiveHealth Online next time you need to see a doctor right away. Your PCP copayment or coinsurance will applyfor the cost of the visit.Future Moms 800-828-5891Expecting? Enroll in Future Moms for free pre- and post-natal support to help ensure a healthy pregnancy. It’s there for you, yourspouse, or other covered dependents. Since no two pregnancies are alike, be sure to enroll whether it’s your first or third baby that’son the way.ConditionCare 800-445-7922Take advantage of free and confidential support to manage these conditions:AsthmaDiabetesChronic obstructive pulmonary disease (COPD)Heart failureCoronary artery disease (CAD)High cholesterolMetabolic syndromeHypertensionObesityYou may receive a call from ConditionCare if your claims indicate you or an enrolled family member may be dealing with one ormore of these conditions. While you’re encouraged to enroll and take advantage of help from registered nurses and other healthcare professionals, you may also opt out of the program when they call.Quit for Life Tobacco Cessation 866-784-8454This nationally acclaimed program is free, confidential, and it works! When you’re ready to be tobacco free, you don’t have to quitalone. Call or go to www.quitnow.net/commonwealth to get all the help you need.MyHealth AdvantageYou may receive a MyHealth Note in the mail. It’s our way of reminding you about important health screenings and other medicalreminders. It also gives you a convenient summary of your recent medical claims, prescriptions and money saving health care tips.Anthem.com/tlcThis is your “go to” site for detailed information about your plan, including benefit summaries and your member handbook. Nologin or registration is needed.Anthem.comBe sure to register at anthem.com so you can access your personal, confidential plan information including claims. You can Finda Doctor, print a temporary ID card, order home delivery prescriptions refills, and check your claims from here. Use the EstimateYour Cost tool to compare costs at different facilities for more than 400 medical procedures.Go mobile! Be sure to download the Anthem Blue Cross and Blue Shield app to your smart phone. It’s great to be ableto find a doctor or the nearest Urgent Care Center on the go. Log in to the app and see all the other things you can doright from your phone.
I F YO U N E E DA S S I S TA N C EANTHEM BLUE CROSS AND BLUE SHIELDAnthem Member Services(medical, outpatient pharmacy and routine vision)1-800-552-2682Monday through Friday 8:00 a.m. – 6:00 p.m.Saturday 9:00 a.m. – 1:00 p.m.www.anthem.com/tlcAnthem Behavioral Healthcare andEmployee Assistance Program1-855-223-9277www.anthemeap.com(Company Name: Commonwealth of Virginia)24/7 Nurseline1-800-337-4770LiveHealth OnlineLiveHealthOnline.comDELTA DENTAL OF VIRGINIARoutine Dental Care1-888-335-8296www.deltadentalva.comTHE LOCAL CHOICEThe Local Choice Health Benefits Program ommonwealth of VirginiaCDepartment of Human Resource Management101 North 14th Street – 13th FloorRichmond, VA 23219www.thelocalchoice.virginia.govNOTE: This is not a policy. This is a brief summary of the Key Advantage 1000 health benefits plan.The Key Advantage Member Handbook, along with this Benefits Summary, constitute a completedescription of the benefits, exclusions, limitations and reductions under the plan. Be sure to keep thissummary with your Key Advantage Member Handbook for a full description of your coverage.A10183 (1/2016)
supply when you use the home delivery pharmacy. Q. Can I get a brand name drug instead of a generic? You have a mandatory generic drug program. However, if there is no generic equivalent for the drug, you may get the brand and pay only the applicable copayment. If there is a generic equivalent available, you may opt to use the brand,
