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Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - Moore Wallace   
How the Prescription Drug Program Works
How to Fill Your Prescriptions Through the Mail Service Pharmacy
If you or your spouse/domestic partner needs to take a prescription drug for an extended period of time, you can purchase such prescriptions through the mail (maximum 90-day supply). Your medications are delivered to your home. Purchasing prescription drugs through the mail service pharmacy enables you to minimize your out-of-pocket costs for long-term maintenance prescriptions.
To fill your prescriptions through the mail service pharmacy:
 | Complete a confidential Mail Service Order Form when you or your spouse/domestic partner submits the first prescription by mail. It is important to complete the form for all individuals for whom you or your spouse/domestic partner is requesting a prescription. If you or your spouse/domestic partner changes or adds medications, or you or your spouse/domestic partner has a medical condition that you or your spouse/domestic partner did not previously report, you or your spouse/domestic partner must update your profile.
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| Ask your provider to write a prescription for a 90-day supply, plus the appropriate refills for up to a maximum of one year. (After the one-year period, a new prescription is required.) Submit the original prescriptions with the covered individual’s name and ID number clearly marked on the back. Also include the completed Mail Service Order Form (you may want to keep a copy for your records).
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| Submit your copayment (by either check or credit card number). If you pay by credit card, you or your spouse/domestic partner can order refills by phone or online (provided your original prescription is valid). After you or your spouse/domestic partner uses all of the refills noted on the original prescription, you or your spouse/domestic partner needs to submit a new prescription as outlined above. |
Coverage under the Program ends when any of the following conditions occur:
| A covered individual has received the maximum $2 million in benefits under the Retiree Group Health Program for all illnesses. If coverage for a retiree ends because the maximum $2 million in benefits has been paid, coverage for his or her spouse/domestic partner continues until termination of the spouse/domestic partner’s coverage because the spouse/domestic partner has received $2 million in benefits under the Retiree Group Health Program or for any of the other reasons listed below.
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| A covered individual dies. However, if a retiree has coverage under the Program and dies, the retiree’s spouse/domestic partner can continue his or her coverage under the Program, regardless of whether he or she remarries or becomes eligible under another employer’s plan.
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| You do not pay the required premiums for coverage. Payment is due on or before the effective date of coverage, which is the first of each month. If payment is not received within 30 days of the effective date of coverage, coverage for you and your spouse/domestic partner is terminated retroactively as of the date through which full payment was received. Coverage under the Program can be reelected only during Annual Enrollment.
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| In the event of a legal separation or divorce, coverage for a spouse/domestic partner is automatically terminated as of the date the legal separation or divorce occurs.
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| The Program or Plan (in whole or in part) can be discontinued for any reason.
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| If you are reemployed by RR Donnelley in a benefits-eligible position 30 or more days after your termination date, and you have already enrolled in this Program, your coverage under the Program will be suspended. As an active employee, you must select from the available options offered under the Active Program if you want coverage. Because you cannot be simultaneously covered under both the Active Program and this Program, you will not be able to remain covered under this Program. When you next terminate employment, you will again be eligible for coverage under this Program. |
In some cases, you or your spouse/domestic partner may continue coverage under COBRA if his or her coverage under this Program ends.
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