How the Plan Works
The claims administrator for the Plan is Elixir (formerly known as EnvisionRxOptions). Your benefits under the Plan are based on the type of drug and where you obtain it. The amount you pay, after the Plan pays benefits, is a percentage (as shown in "Highlights of the Plan") based on the Elixir-discounted total cost of the drug. Your share of the cost is your coinsurance. For most drugs available in the marketplace, the coverage tier that applies is indicated in the Covered Medication Search tool.
On-Site Clinic
Many approved over-the-counter drugs can be obtained at no cost to you, when prescribed and dispensed at an on-site clinic, available at most Alliance Coal mines and offices. For the types of drugs generally available, see "Approved Over-the-Counter Drugs."
In-Network Pharmacy
An up-to-date list of In-Network pharmacies is available using the Elixir online Pharmacy Locator. To fill or refill a prescription at an In-Network pharmacy, present your Alliance Coal Health Plan ID card and pay the appropriate coinsurance for each drug you receive. The pharmacy will submit claims directly to Elixir for payment.
Out-of-Network Pharmacy
Drugs from Out-of-Network pharmacies will often cost you more than drugs from In-Network pharmacies. Therefore, when possible, consider purchasing any needed drugs at In-Network pharmacies.
If you have a prescription filled or refilled at an Out-of-Network pharmacy, you pay the pharmacy's retail (nondiscounted) price in full. You then file a claim with Elixir for reimbursement. You will be reimbursed for the amount the Plan would have paid to an In-Network pharmacy. In other words, your reimbursement will be the Elixir-discounted price, reduced by the applicable coinsurance. To file a claim, see “How to File a Claim”.
Maintenance Medications
If your doctor prescribes a covered maintenance medication, you have the option of filling the prescription through the Elixir Pharmacy home delivery (mail order). You can receive up to a 90-day supply of your prescribed medication – delivered right to your home or on-site clinic. Your prescription(s) will usually arrive in 7-14 business days.
To order a maintenance medication, follow these steps:
- First, have your doctor write a prescription for up to a 90-day supply of your medication. The prescription should include refills for up to one year, if appropriate.
- Second, submit your order in one of three ways:
- Internet: Visit elixirsolutions.com, and register or log in to your Mail Portal,
- Telephone: Call (866) 909-5170, or
- Mail: Mail your completed order form to the address shown on the form.
Specialty Drugs
Specialty drugs are complex therapies, often with special storage and handling requirements. The Plan generally covers specialty drugs only when provided by Elixir Specialty. For more information about coverage for special medications, see the “Specialty Drugs” section.
To contact Elixir Specialty, call (877) 437-9012 toll free or order online by logging in to your Mail Portal at elixirsolutions.com. Normally, specialty drugs will be shipped by an overnight carrier arriving the next day.
Infusion Therapy Drugs
In addition to the benefit levels shown in Benefit Summary, the Plan pays 100% of Allowable Charges (no copay or coinsurance) for infusion services when the services are provided at an on-site clinic or an alternate site (including at-home administration) arranged through Care Coordination.
