Plan Administration

MBA handles all aspects of Plan Administration for its clients. This includes but is not limited to:

Utilization Management

Utilization Management is comprised of Pre-certification, Utilization Review, Case Management and Organ Transplant procedures and is designed to help ensure covered persons receive necessary and appropriate health care while avoiding unnecessary expenses for specified items and services requiring pre-certification.

MBA draws on the expertise of a recognized leader in health management, Strategic Health Development Corporation (SHDC), for all its utilization management needs. The Utilization Management component of Strategic Health is accredited by the American Accreditation HealthCare Commission (URAC).

Preferred Provider Networks (PPN)

MBA maintains contracts with the largest national preferred provider organizations along with many regional preferred provider organizations to allow members access to discounted medical services from participating providers. MBA continually analyzes and monitors the performance, access, and value of each of PPN to ensure the greatest access and level of savings to client members.

Check the back of your ID card to determine which preferred provider network is available to you in your area. You may also visit the respective PPN website by clicking on the appropriate link below. Most websites will provide a wealth of resources and allow you to search for local participating healthcare providers and facilities to meet your specific needs.

CVS Caremark
Pharmacy Benefit Manager

CVS Caremark (formerly PharmaCare) is the chosen Pharmacy Benefit Manager for your plan and operates
a national retail pharmacy network with over 56,000 participating locations. CVS Caremark is the most
diversified pharmaceutical care management company in the country holding leading positions in pharmacy
benefit management services, mail-services, specialty drug pharmacy and clinic pharmacy services.

RETAIL CO-PAY PLANS
Members simply show their ID cards to the pharmacist/sales clerk and receive their prescription for a
pre-determined co-payment. There are no claims forms to submit. Members are always encouraged to seek
generic prescriptions to save out of pocket co-pay costs or additional fees that may apply. Contact the
Pharmacy Help Desk at 1-800-777-1023 for more information about copays that apply to your group’s
prescription plan.

PRESCRIPTION DISCOUNT CARD OPTIONS
For groups electing the Prescription Discount Card Option or that have employees that have elected
Qualified High Deductible Health Plan (QHDHP), a prescription drug card will be issued from CVS
Caremark. This card will provide the most aggressive prescription drug discounts available to us; however,
the member will be required to pay for the prescription at the point of sale and submit claims for application
of these expenses to be applied to the medical plan benefits for reimbursement, when applicable.

How The Program Works

1. Member presents their ID card with their prescription upon arrival to the participating pharmacy. If
the member has had previous coverage under another plan they should inform the pharmacist to
update their profile so that the claim will be processed under the correct program.

2. The pharmacist will then enter the prescription information that is being purchased along with their
usual and customary price for the prescription. The pharmacist will then enter the subscriber’s Social
Security Number and 6-digit CVS Caremark group number into their on-line adjudication system.
The CVS Caremark system calculates the preferred pricing for the medication and electronically
relays this information to the pharmacist.

3. The member pays the preferred price at the time of service.

4. The member should then send the ORIGINAL prescription receipt, along with the Prescription Drug
Benefit Claim Form to the claims address listed on the Claim Form.

MAIL ORDER PRESCRIPTION PROGRAM
For greater convenience and additional cost savings, members are encouraged to use CVS Caremark mail
service pharmacy to order maintenance medications. Members send prescriptions or refill orders to CVS
Caremark where they are processed and dispensed before being mailed to the member’s home or office.
Members should contact CVS Caremark for appropriate forms, instructions, or more information at www.caremark.com.

Brochure about CVS Caremark
Caremark Informational Brochure (PDF)

Links below to the appropriate CVS Caremark prescription drug claim form.

CVS Caremark Forms
Caremark Rx Reimbursement Claim form (PDF)
Caremark Rx Mail Order form (PDF)
Caremark Drug List (PDF)