Retiree Health Summary Plan Description
As of February 1, 2018
En Español (PDF)

5.5 Non-Network Pharmacy Reimbursements

You are encouraged to use network pharmacies or the Citizens Rx Home Delivery service to fill your prescriptions. However, the Retiree Health Plan will reimburse you a limited amount for a prescription filled at a non-network pharmacy. This policy is intended for emergency purposes (e.g. traveling away from home). You may obtain up to a 30-day supply.

Non-network pharmacy claim forms are available from the Administrative Office or on You will fill out one portion of the claim form. The pharmacy must fill out the rest of the form.

Completed claim forms should be mailed to:

Citizens Rx
1144 Lake Street
Oak Park, IL 60301
4th Floor

Claims will generally be processed within 30 days from the date the claim is received. You will be reimbursed based on a limited formula, less a $5 co-payment for each generic prescription and a $15 co-payment for each brand name prescription.

You must file your claim within 15 months of the date the prescription was filled.