Prescription Drug Coverage

Prescription Drug Coverage

The Health & Welfare Fund determines, administers and pays prescription drug benefits. The Plan partners with Blue Shield of California to provide network access and help you take advantage of discounts on most prescription medications.

Deductible - The deductible is the amount you owe each calendar year for covered prescription drugs before the Plan begins to pay. Your Plan has a $50 deductible per covered person for prescription drugs.

Once the $50 calendar year deductible is met, the Plan reimburses between 50% - 100% of covered charges for each covered person depending on the tier where the prescription drug is placed and your total charges in a calendar year. Prescription drugs are reimbursable at 100% for the first $1,800, 50% of the next $4,200 and 65% of incurred expenses exceeding $6,000 in a calendar year for each covered person. 

See your Summary Plan Description for details about prescription drugs, restrictions and exclusions. If you are not sure whether an item is covered, call the Fund Office at (800) 595-7473. Or, if outside California, call (213) 385-6161.

REMINDER: Ask About Generic Drugs. They cost less yet provide the same clinical benefits as brand-name versions. Choosing generic drugs may make your out-of-pocket costs even lower. Compare drug prices from different pharmacies. You can also save money by requesting a 90-day supply, especially through mail-order options.

How to Submit Prescription Drug Claims - You must submit prescription drug claims to the Fund Office for reimbursement by sending a properly completed Prescription Drug Claim Form along with a receipt or printout from a licensed pharmacy that includes all the following information:

  • Patient’s Name
  • Medication Name
  • Prescription (Rx) Number
  • National Drug Code (NDC) Number
  • Date Filled
  • Prescribing Doctor’s Name
  • Amount Paid
  • Pharmacy Name, Address and Phone Number

Refer to the Summary Plan Description, or contact the Fund Office for more information.

Outside the United States

Services, prescriptions, medications and supplies purchased outside the United States and its territories are excluded, unless the services, medications or supplies were the result of an accident or life-threatening emergency medical condition that occurred outside of the United States and its territories or the participant submits proof of residency in the country where the services were rendered. 

Click here for Frequently Asked Questions about Prescription Drug coverage.

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