Prescription Benefits

Retail Pharmacy & Mail Order Prescription Benefits

Not all members have access to all prescription drug services. Review your Certificate of Insurance for benefits.

Prescription benefit coverage provided under the plan includes benefits for both retail pharmacies as well as two mail order prescription drug programs. One mail order prescription drug program is designed for members residing in the United States. The second mail order prescription drug program is designed for members residing overseas. For a full list of covered and non-covered services, see your Certificate of Insurance.

Retail Pharmacies

Members have access to over 44,000 participating pharmacies within the United States. Members are responsible for paying 100% of the co-payment at retail pharmacies or members may file a claim for reimbursement for purchases made at retail pharmacies. For reimbursements, simply complete a Prescription Claim Form and submit directly to the claims administrator, GeoBlue for reimbursement.

Drug Formulary Guide

Mail Order Program if Residing in the United States

Provided by EnvisionPharmacies.

Online: Visit the website at www.envisionpharmacies.com

Phone: Call EnvisionPharmacies at 1-888-773-6380, U.S

Hours: EnvisionPharmacies Customer Care Representatives and Clinical Pharmacists are available 24 hours daily.

To submit prescriptions, prescribers can reach EnvisionPharmacies by:

E-Prescribe or EDI Number NCPDP 36-77361
Phone: 1-888-773-6380 U.S.
FAX: 1-866-909-5171

Or prescriptions can be mailed to:

EnvisionPharmacies
7835 Freedom Ave NW
North Canton, OH 44720

To enroll in the mail order program, you can call the above number or you can enroll online at www.envisionpharmacies.com/mail. Once you've establish an account, you can log into your profile to reorder medications or place new orders.

Mail Order Program if Residing Outside the United States

Provided by Expatriate Prescription Services (EPS). Expatriate Prescription Services (EPS) has a licensed pharmacy staff with a wealth of experience delivering medications to over 160 countries.

To place an order, you can call EPS at the below number or complete the online order form at www.expatps.com. Submit your prescription details via email to eps@universalrx.com or fax your prescription(s) to 540-777-7184.

Online: www.expatps.com

Phone: call an EPS Representative to order outside of the U.S. at 540-777-1450; hours: 8:30am - 5:00pm EST, U.S.

Fax: 540-777-7184.

Email: Email a copy of your prescription(s) to eps@universalrx.com.

If you choose to use a pharmacy outside of this program, or if EPS is unable to ship to your location, you must pay out of pocket and submit a claim form for reimbursement. For reimbursements, complete a Prescription Claim Form and submit directly to the claims administrator, GeoBlue, for reimbursement. If you need assistance in locating a pharmacy while outside of the U.S. call GeoBlue toll-free in the U.S.1.855.282.3517; collect from outside the U.S. 1.610.254.5304; or email globalhealth@geo-blue.com.

Questions?

If you have questions regarding your benefits or the information in your certificate, contact GeoBlue for more information.

Phone: +1 610.254.5304 (Collect Calls Accepted) or +1 855.282.3517 (U.S. Toll Free)

Email: customerservice@geo-blue.com; someone will respond on the next business day.

Find a Pharmacy

Locate a participating pharmacy online at

universalrx.com

Present your medical and prescription ID card to the participating pharmacy.