RX Copay Summary
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UMWA Health and Retirement Funds

RX Copay Summary

The amount you will need to pay for prescription drugs depends on the Funds plan in which you are enrolled. The copayment year, the copayment amount and the maximum out-of-pocket amount is different for each plan listed below. If you have any questions, please call the Call Center at 1-800-291-1425, option 2.


 

Plan

Copayment Year

Retail PPL* (In-Network)/non-PPL (Out of Network) Copay

(Per 30-day supply)

Mail Copay

(Per 90-day supply)

Non-Preferred Drug Surcharge (Per 30-day Supply)

UMWA Combined Benefit Fund

March 27 – March 26

$5/$5**

$0

No

UMWA 1992 Benefit Plan

Jan 1 – Dec 31

$5/$5**

$0

No

1993 Plan Traditional Program of Benefits

Jan 1 – Dec 31

$15/$30

$5

No

1993 Plan Alternate Program of Benefits

Jan 1 – Dec 31

$25/$40

$10

No

1993 Plan Post-Legislative Program of Benefits

Jan 1 – Dec 31

$15/$30

$5

No

1993 Plan Individual Employer Program of Benefits (Eligible Active Employees and Non-Coal Act Retirees of Murray American Energy, Inc. and its related entities)

Jan 1 – Dec 31

$20/$35

$30

1st fill - $0

1st refill - $10 (plus copay)

Additional refills - $20 (plus copay)

1993 Plan Section 9711 Program and Benefits (Eligible Coal Act Retirees of Murray American Energy, Inc. and its related entities)

Jan 1 – Dec 31

$5/$5**

$0

1st fill – 0

1st refill - $10 (plus copay)

Additional refills - $20 (plus copay)

 

1993 Plan UMWA Program of Benefits (Eligible Employees and Retirees of UMWA)

Jan 1 – Dec 31

$20/$35 ****

$30

1st fill - $0

1st refill - $10 (plus copay)

Additional refills - $20 (plus copay)

1993 Plan Individual Employer Program of Benefits (Murray Oak Grove Coal, LLC)

Jan 1 – Dec 31

$5/$10**

$0

1st fill - $0

1st refill - $7.50 (plus copay)

Additional refills - $15 (plus copay)

UMWA Prefunded Benefit Plan—Carbontronics

Jan 1 – Dec 31

$15/$30

$5

No

UMWA Prefunded Benefit Plan–Eligible Coal Act Retirees of Energy West Mining Company

Jan 1 – Dec 31

$5/$5**

$0

No

UMWA Prefunded Benefit Plan–Eligible Non-Coal Act Retirees of Energy West Mining Company

Jan 1 – Dec 31

$15/$30***

$5

No


*PPL-Participating Provider Lists​

**Maintenance Choice Program – If a 90-day supply is obtained at a CVS retail pharmacy - $0 copay per 90-day supply

***Maintenance Choice Program – If a 90-day supply is obtained at a CVS retail pharmacy - $5 copay per 90-day supply

****Maintenance Choice Program – If a 90-day supply is obtained at a CVS retail pharmacy - $30 copay per 90-day supply

 

 

Other information about above plans:

Specialty Pharmacy Medications are limited to a 30-day supply.

Beneficiaries will need to submit a manual claim; higher copayments may apply. 

Non-preferred specialty medications require medical necessity approval and evidence of failure with preferred drugs before coverage is allowed.​

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