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At least one generic drug and at least one brand name drug from the health plan's Drug Formulary that is used in the treatment of certain chronic conditions for which member cost share may be reduced or waived. Refer to rider for more information.

Es posible que ciertos medicamentos recetados, genéricos o de marca, para el asma, la diabetes y ciertas afecciones cardíacas tengan un costo compartido reducido o exento, según lo exige la ley estatal. Consulte la cláusula adicional para obtener más información.

Cryopreservation and storage of reproductive tissue as outlined in the applicable medical policy.

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Opioid antagonists that are dispensed to the member upon discharge by the health care facility in which they were prescribed. These will be covered under the health plan's medical benefits. In most cases this health plan will provide full coverage (any deductible copayment and/or coinsurance will not apply) for covered opioid antagonists furnished under the medical benefits (any prior approval is not required). There is one exception. If the health plan is a Saver high deductible health plan the overall deductible will still apply. See Prescription Drugs for when these items are purchased at a pharmacy or dispensed by a pharmacist.

For CT scans MRIs and PET scans received during emergency room visits only the emergency room copayment will be charged; no separate CT scans MRIs and/or PET scans copayments or additional physician copayments will be charged.

Opioid antagonists that are dispensed to the member upon discharge by the health care facility in which they were prescribed. These will be covered under the health plan's medical benefits. In most cases this health plan will waive any copayment and/or coinsurance for covered opioid antagonists furnished under the medical benefits (any prior approval is not required). The overall deductible will still apply. See Prescription Drugs for when these items are purchased at a pharmacy or dispensed by a pharmacist.

Opioid antagonists that are dispensed to the member upon discharge by the health care facility in which they were prescribed. These will be covered under the health plan's medical benefits. In most cases this health plan will waive any copayment and/or coinsurance for covered opioid antagonists furnished under the medical benefits (any prior approval is not required). The overall deductible will still apply. See Prescription Drugs for when these items are purchased at a pharmacy or dispensed by a pharmacist.