How the Plan Works
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 Envision-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 on the Covered Medication Search.
On-Site Health Center
Many approved over-the-counter drugs can be obtained at no cost to you, when prescribed and dispensed at an on-site Health Center, available at most Alliance Coal mines and offices. For the types of drugs generally available, see "Health-Center Drugs."
An up-to-date list of In-Network pharmacies is available using the EnvisionRxOptions online Pharmacy Locator. To fill or refill a prescription at an In-Network pharmacy, present your EnvisionRxOptions identification card and pay the appropriate coinsurance for each drug you receive. The pharmacy will submit claims directly to EnvisionRxOptions for payment.
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 EnvisionRxOptions 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 EnvisionRxOptions-discounted price, reduced by the applicable coinsurance.
To file a claim with EnvisionRxOptions:
- Complete a reimbursement form. The form is also available from your local HR representative or by calling EnvisionRxOptions Customer Service at (800) 361-4542.
- Mail the form to:
2181 E. Aurora Rd. – Suite 201
Twinsburg, OH 44087
If your doctor prescribes a covered maintenance medication, you have the option of filling the prescription through the EnvisionMail mail-order pharmacy. You can receive up to a 90-day supply of your prescribed medication – delivered right to your home or on-site Health Center. 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 envisionrx.com/login, and register or log in to your account,
- Telephone: Call (866) 909-5170, or
- Mail: Mail your completed order form to the address shown on the form.
Specialty drugs are complex therapies, often with special storage and handling requirements. The Plan generally covers specialty drugs only when provided by EnvisionSpecialty or by Thrifty Pharmacy. For more information about coverage for special medications, see the “Specialty Drugs” section.
To contact EnvisionSpecialty, call (877) 437-9012 toll free or order online at envisionspecialty.com. Health care providers can call EnvisionSpecialty at (877) 437-9013. Normally, specialty drugs will be shipped by an overnight carrier arriving the next day. To contact Thrifty Pharmacy, you or your health care provider can call (270) 667-2049.
Compound drugs are medicines that are custom-made for an individual patient. Creating these drugs requires special expertise, and errors can have serious consequences. The Plan covers compound drugs only when provided by EnvisionCompounding. Your coinsurance percentage is based on the coverage tier for the main active ingredient (e.g., you pay 30% for a Brand-Name Non-Preferred Drug).
To contact EnvisionCompounding to order a compound drug, call (866) 909-5170 toll free or order online at envisioncompounding.com. Health care providers can contact the compounding pharmacy at (866) 909-5170 (option 4) or by fax at (844) 429-6891. Normally, compound drugs will be delivered by a ground shipping service (such as UPS or FedEx), or by a second-day air refrigerated service if required for the medication type.
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 Health Center or an alternate site (including at-home administration) arranged through Care Coordination.