Frequently Asked Questions

Need to define a word? Check the Glossary for a list of common healthcare terms.

Prescription

  • If you are prescribed a long-term maintenance medication, you should use Maintenance Choice or CVS/Caremark Mail Service Pharmacy by the third fill, or the prescription will be subject to a 50% co-insurance payment and the plan limit on the maximum co-payment per prescription will not apply.

  • If you purchase a brand-name drug when a generic equivalent is available, you will pay your generic co-insurance plus the difference in cost between the brand-name and the generic drug. The limit on the maximum co-payment per prescription does not apply for brand-name drugs when a generic equivalent is available. Please refer to your Plan Benefit Profile in the My Documents section of your Member Dashboard for specific coverage.

  • TeamCare does not cover medication or supplies ordered from outside the United States, over the counter medications, vitamins, or dietary supplements. For a complete listing of non-covered items under your Prescription Benefit, please refer to your Summary Plan Description in the My Documents section of your Member Dashboard.

  • You will need to submit itemized receipts from your pharmacy to:

    TeamCare
    A Central States Health Plan
    P. O. Box 5116
    Des Plaines, IL 60017-5116

    Consult your TeamCare Benefit ID card and make sure that all information is accurate on the claim.

     

  • There are many reasons a prescription can be rejected, such as a problem with eligibility, trying to get a non-covered drug, or having other insurance. Ask the pharmacy why the prescription was rejected and contact TeamCare for assistance.

  • You can access a mail order prescription form by visiting Caremark.com.

  • Yes, for covered medications.

  • You can access your prescription history by visiting Caremark.com.

  • No, there is not a mandatory formulary. A prescription drug formulary is a list of commonly prescribed medications that have been selected by Caremark because of their combination of effectiveness and cost.

    Your doctor should call Caremark or visit caremark.com to learn which drugs are covered under your Prescription Benefit. You should encourage your physician to prescribe preferred medications whenever possible, because drugs not on the formulary will not be covered and will cost you more money.

  • Yes, there is a separate annual out-of-pocket maximum that applies only to injectable medications. Once your out-of-pocket for prescription medications costs reach the annual limit of $1,000, all future injectable medication costs will be paid at 100%. Please refer to your Plan Benefit Profile to find the specific information for your injectable medication coverage and to determine exactly what your Prescription Drug Benefit covers—and doesn’t cover.

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