• Seeing a Doctor Out-of-Network
• Fill a Prescription Out-of-Network
• Enrollment
  • Eligibility
  • Disenrollment

FILLING A PRESCRIPTION OUT-OF-NETWORK

Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

• Before you fill your prescription in these situations, call Member Services to see if there is a network pharmacy in your area where you can fill your prescription. If you do go to an out-of-network pharmacy for the reasons listed below, you may have to pay the full cost (coinsurance OR co-payment) when you fill your prescription. You may ask us to reimburse you for our share of the cost by submitting a paper claim. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy, as any amount you pay for a covered Part D drug will help you qualify for catastrophic coverage. If we do pay for the drugs you get at an out-of-network pharmacy, you may still pay more for your drugs than what you would have paid if you had gone to an in-network pharmacy.
  • Drugs purchased out-of-network
  • Drugs paid for in full when you don’t have your membership card.
  • Drugs paid for in full in other situations
  • Drugs purchased at a better case price
  • Copayments for drugs provided under a drug manufacturer patient assistance program.

In these situations, please check first with Member Services to see if there is a network pharmacy nearby

How do you ask for reimbursement from the plan?

If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than paying your normal share of the cost) when you fill your prescription. You can ask us to reimburse you for our share of the cost.

How and where to send us your request for payment

Send us your request for payment, along with your bill and documentation of any payment you have made. It’s a good idea to make a copy of your bill and receipts for your records.

Mail your request for payment together with any bills or receipts to us at this address:

Florida Health Care Plans
Attn: Claims Department
P.O. Box 9910
Daytona Beach, FL 32120

Please be sure to contact Member Services if you have any questions. If you don’t know what you owe, or you receive bills and you don’t know what to do about those bills, we can help. You can also call if you want to give us more information about a request for payment you have already sent to us.