Active Health Summary Plan Description
As of September 1, 2017
En Español (PDF)
The following items are a covered benefit subject to the limitations as stated below:
- Drugs for sexual dysfunction for both males and females are limited to a maximum of eight (8) pills for a 30-day supply and the co-payment will be the same as any other drug.
- Smoking deterrents when prescribed in writing, by a physician, subject to the following limitations: up to 90 days' supply per year; lifetime maximum benefit, 180 days' supply.
This limitation applies to smoking deterrents received from both retail and mail pharmacy outlets. It is recommended you discuss a treatment plan with your physician. There are many products to assist you in smoking Cessation. These include the following:
- Nicotine Patches
- Nicotine Gum
- Nicotine Nasal Spray (Rx Required)
- Nicotine Inhalers (Rx Required)
- Nicotine Lozenges
- Zyban (Bupropion) (Rx Required)
- Morning after pills and kits (i.e., Preven, Plan B) - (limited to two (2) total per person per 365 days)