Prescription Drug Benefits
with UniCare (Wellpoint NextRx)
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Policy Number: 141249
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RX Bin #610053
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$100 annual deductible
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Co-payment schedule:
$20 co-pay - generic
$45 co-pay - Preferred Brands
$65 co-pay - Non-Preferred Brands -
Prescription Drug Maximum per plan year of $2,000
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Exclusions from last year still apply (see below)
In order to access this program, follow the procedures outlined below:
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Go to a pharmacy that is within the UniCare network. The following is a representative list of network pharmacy chains: Kmart, King Soopers, Rite-Aid, Safeway, Target, Longs, and Wal-Mart. The UNC Student Health Center does not participate with any prescription drug plans.
In addition, several other independent pharmacies may be used. This is a statewide and nationwide network of pharmacies. Contact the Student Insurance Office or 888-218-4844 for more information.
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Present your insurance I.D. card to the pharmacy and/or identify yourself as a participant in the plan. Eligible status is on-line at the pharmacy.*
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After your prescription is filled, you will be required to pay the deductible and applicable Co-payment. All information concerning your eligibility and any Plan limitations is on-line at the pharmacy.
Note: The prescription drug plan co-payment does not apply to the Plan Deductible. Outpatient prescription drugs are only eligible expenses if obtained at network pharmacies.
Eligibility and deductible status will not be on-line at the pharmacy until approximately 1 1/2 to 2 months after the coverage begins for the semester. Until the pharmacies have the information available to them online, the student will need to contact the Student Health Insurance Office to make arrangements for obtaining your prescription.
The pharmacies will have online access to the eligibility list and their computer system will keep track of the deductible paid/remaining and amount to bill the insurance.
EXCLUSIONS
The following exclusions apply:
All over the counter medication (OTC's), medical devices; Nicorette gum or smoking cessation medications, Rogaine; Retin A; Anabolic Steroids, anorexiants, oral contraceptives, contraceptive devices including patches, NuvaRing, injections, IUD's and diaphragms, fertility drugs; drugs and medications for the treatment of impotence and/or sexual dysfunction, compounds, vitamins if OTC, legend vitamins, and experimental drugs.
There may be additional exclusions to those listed above.
Insurance Company (carrier) Information
