Common use of Payment of Claims – Covered Prescription Drugs Clause in Contracts

Payment of Claims – Covered Prescription Drugs. If the Member purchases a covered Prescription Drug from a Contracting Pharmacy Provider, the benefit payment is made directly to the Contracting Pharmacy Provider and is accepted as payment in full, except for any applicable Deductible, Copayment or Coinsurance. The Member is responsible for any applicable Deductible, Copayment or Coinsurance and the Contracting Pharmacy Provider may bill the Member directly for such amounts. If the Member purchases a covered Prescription Drug from a non-Contracting Pharmacy Provider, the Member is responsible for paying the total charge and submitting a claim to CareFirst BlueChoice or its designee for reimbursement. Except in cases of Emergency Services or Urgent Care received outside of the Service Area, the difference between the non-Contracting Pharmacy’s actual charge and the Prescription Drug Allowed Benefit is a non-covered service. In cases of Emergency Services or Urgent Care received outside of the Service Area, Members will be entitled to reimbursement from CareFirst BlueChoice or its designee up to the amount of the total charge, minus any applicable Deductible, Copayment or Coinsurance. In all other cases, Members will be entitled to reimbursement from CareFirst BlueChoice or its designee for the amount up to the Prescription Drug Allowed Benefit, minus any applicable Deductible, or Copayment or Coinsurance.

Payment of Claims – Covered Prescription Drugs. If the Member purchases a covered Prescription Drug from a Contracting Pharmacy Provider, the benefit payment is made directly to the Contracting Pharmacy Provider and is accepted as payment in full, except for any applicable Deductible, Copayment or Coinsurance. The Member is responsible for any applicable Deductible, Copayment or Coinsurance and the Contracting Pharmacy Provider may bill the Member directly for such amounts. If the Member purchases a covered Prescription Drug from a non-Contracting Pharmacy Provider, the Member is responsible for paying the total charge and submitting a claim to CareFirst BlueChoice or its designee for reimbursement. Except in cases of Emergency Services or Urgent Care received outside of the Service Area, the difference between the non-Contracting Pharmacy’s actual charge and the Prescription Drug Allowed Benefit is a non-covered service. In cases of Emergency Services or Urgent Care received outside of the Service Area, Members will be entitled to reimbursement from CareFirst BlueChoice or its designee up to the amount of the total charge, minus any applicable Deductible, Copayment or Coinsurance. In all other cases, Members will be entitled to reimbursement from CareFirst BlueChoice or its designee for the amount up to the Prescription Drug Allowed Benefit, minus any applicable Deductible, or Copayment or Coinsurance.

Payment of Claims – Covered Prescription Drugs. If the Member purchases a covered Prescription Drug from a Contracting Pharmacy Provider, the benefit payment is made directly to the Contracting Pharmacy Provider and is accepted as payment in full, except for any applicable Deductible, Copayment or Coinsurance. The Member is responsible for any applicable Deductible, Copayment or Coinsurance and the Contracting Pharmacy Provider may bill xxxx the Member directly for such amounts. SAMPLE If the Member purchases a covered Prescription Drug from a non-Contracting Pharmacy Provider, the Member is responsible for paying the total charge and submitting a claim to CareFirst BlueChoice or its designee for reimbursement. Except in cases of Emergency Services or Urgent Care received outside of the Service Area, the difference between the non-Contracting Pharmacy’s actual charge and the Prescription Drug Allowed Benefit is a non-covered service. In cases of Emergency Services or Urgent Care received outside of the Service Area, Members will be entitled to reimbursement from CareFirst BlueChoice or its designee up to the amount of the total charge, minus any applicable Deductible, Copayment or Coinsurance. In all other cases, Members will be entitled to reimbursement from CareFirst BlueChoice or its designee for the amount up to the Prescription Drug Allowed Benefit, minus any applicable Deductible, or Copayment or Coinsurance.