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Appropriate immunizations as recommended by the Advisory Committee on Immunization Practices but only when they are furnished by an OB/GYN physician or OB/GYN nurse practitioner.

The member's cost share is waived when outpatient medical care services are furnished by the employer group's designated onsite health center.

The member's in-network cost share will apply when outpatient medical care services are furnished by the employer group's designated onsite health center.

Fitness and Weight Loss Program - you and your covered family members can be reimbursed up to $150 (in total) for membership and class fees paid to a health club with cardiovascular and strength-training equipment; a fitness studio with instructor-led group classes; or a weight loss program that is hospital-based, or non-hospital-based that includes behavioral/lifestyle counseling with certified health professionals (in-person, phone, online). You can request this reimbursement each calendar year; requests must be submitted by March 31 of the following year. You cannot be reimbursed for initiation fees, personal training, country clubs, social clubs, sports teams, spas/pools, instructional dance, gymnastics, martial arts, fitness equipment/clothing, pre-packaged meals; or individual nutrition counseling and other services covered by your medical plan. This reimbursement is a Wellness Participation Program separate from your health plan.

This health plan covers drugs and supplies that are listed on the National Preferred Drug Formulary, prescribed for use out of the hospital (or another health care facility) and purchased from a covered Pharmacy.

This health plan includes a cost share assistance program where drug manufacturers provide financial support to members enrolled for cost share assistance by reducing or removing the initial cost share applied to eligible drugs and/or supplies. For members that choose not to enroll for cost share assistance, the initial cost share applied to eligible drugs and/or supplies is not reduced or removed. For members who cannot enroll for cost share assistance, the initial cost share does not apply and they will pay the cost share that applies for other drugs and/or supplies that are not eligible for cost share assistance. (Refer to the rider and/or cost share assistance drug list for more information about this program and the drugs and/or supplies eligible for cost share assistance.)

Glucometers that are medically necessary due to the patient's type of diabetic condition and obtained from a covered pharmacy.

Insulin infusion pumps and related pump supplies. (The insulin infusion pump must be obtained from an Appliance Company instead of a Pharmacy. For the insulin infusion pump itself, the cost the member would normally pay for covered drugs and supplies will be waived. For the related pump supplies, the copayments and coinsurance will be waived. Member will pay deductible)

Note: Prior authorization may be required before receiving certain Medicare Part B prescription drugs. The member may also have to try a different drug first before the drug requested is covered. This is called step therapy." Contact the plan for details."

Biologically-based mental conditions means: schizophrenia; schizoaffective disorder; major depressive disorder; bipolar disorder; paranoia and other psychotic disorders; obsessive-compulsive disorder; panic disorder; delirium and dementia; affective disorders; eating disorders; post-traumatic stress disorders; autism; substance use disorders (drug addiction and alcoholism); opioid use disorder treatment ; and any biologically-based mental conditions appearing in the most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders that are scientifically recognized and approved by the Commissioner of the Department of Mental Health.