Microsoft word - green shield prescription drugs 2009.doc

Green Shield
Prescription Drug Plan
(A brief Overview)
Effective January 1, 2009
The prescription drug co-pay for actives and retirees will increase to
10% per prescription with a maximum per family of $250 for the 2009 year.
Once the yearly maximum co-pay is reached the active employee or retiree and any of their
covered dependents will no longer be required to pay any deductibles till the new year starts
again the following January 1st .
This yearly co-pay increases on January 1st 2010 to $270/Family/Year and increases on January 1st 2011 to $290/Family/Year. For retirees, dependent spouse’s or surviving spouse’s who are covered by the plan and are over
65 years of age who are on the Ontario Drug Plan (ODB)
Starting January 1st 2009 the first $100 that the government requires you to pay for prescription
drugs will be reimbursed to you through your Green Shield Plan,
minus the 10% co-pay ($10).
After this the retiree, dependent spouse or surviving spouse over 65 will be required to pay 10%
of the dispensing fee for each prescription which presently is $6.11 which works out to be $0.61,
until that years maximum co-pay has been reached.
Our plans Conditional and Exceptional Prescription Drugs
As in the past, our plan will still continue to have some Prescription drugs that are Conditional or
Exceptional. If your doctor has prescribed a drug, which is an exceptional, or a conditional drug
under our plan, your doctor must fill out a prescription drug special authorization form in detail,
including the reason to qualify and any other medical information, as failure to do so could result
in Green Shield denying you coverage for this specific drug.
The prescription drug special authorization form your doctor must fill out, including the outlined
criteria that needs to be meet for these drugs are available through Green Shield by calling
directly at 1-888-711-1119, contacting the in the Plant CAW Benefit office or CAW Local Union
Hall.
Once the form has been completed mail to Green Shield or Fax the drug special authorization
form to Green Shield at 1-519-739-6483 (Note: Green Shield will only accept drug special
authorization forms at this Fax number do not use for any other Green Shield claims.)
Generic Prescription Drug Coverage
Also as in the past, when a prescription drug for a covered person has a legally substitutable
generic equivalent, the maximum benefit under the Plan for such drug will be limited to the cost
of the legally substitutable generic drug.
When the covered person chooses the more costly drug, instead of the lower priced legally
substitutable generic drug, that person will be responsible for the difference in cost. Brand Name
drugs will only be covered by Green Shield when there is clear documented medical evidence
that the legally substitutable generic drug has produced an adverse reaction with the individual
and it has been registered with Health Canada.

Dispensing Fee’s
As our previous contact, any covered person will be responsible for any additional charges
assessed by the nonparticipating pharmacy over and above those paid by the plan, including any
dispensing fee charge over $11.00.

Source: http://www.local707caw.ca/Green%20Shield%20Prescription%20Drugs%20%202009.pdf