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					Prescription Drugs
About This SPD
HMO and PPO Prescription Drugs

The Prescription Drug Program is a component program in the Tenet Employee Benefit Plan
(TEBP). The TEBP is a comprehensive welfare benefits program intended to qualify as a cafeteria
plan within the meaning of Internal Revenue Code (IRC) section 125.

This information summarizes key provisions of the Prescription Drug Program and serves as part of
the summary plan description (SPD) for the TEBP. You can obtain more information about the
Prescription Drug Program, the TEBP and the other component programs offered under the TEBP
by reviewing the complete SPD for the TEBP. If there is any discrepancy between this online SPD
and the official plan documents for the TEBP, the official plan documents will control. For more
information on obtaining the official plan documents, see Other Information.

MODESTO/MANTECA EMPLOYEES: For information on your Prescription Drug
Program for the HMO, see the HMO Medical Plan Details.


Plan Highlights
You must be enrolled in a Tenet medical plan to receive prescription drug coverage. Your choice of
medical plan determines your Prescription Drug Program options.

If you enroll in the HDHP, your prescription drug coverage is part of your medical plan and you will
not have a choice about your Prescription Drug Program option. See your HDHP Medical Plan
Details for more information. Prescription drug benefits under the HDHP are not described this
Prescription Drug Program section of the SPD.

If you enroll in an HMO or a PPO, you choose Prescription Drug Program coverage separately
from your medical plan. You will choose from two prescription drug options — Rx I and Rx III.
Each has a different deductible and coverage level. FOR MODESTO/MANTECA
EMPLOYEES: If you enroll in an HMO in Modesto/Manteca, see the HMO Medical Plan
Details. Prescription drug benefits under the Modesto/Manteca HMO are not described in
this Prescription Drug Program section of the SPD.

The Prescription Drug Program offers an easy and convenient way to save on short- and long-term
medication. The program includes a formulary feature that can help you manage your prescription
drug expenses. A “formulary” is a list of commonly prescribed medications — both generic and
brand name — that have been found to be clinically effective, as well as cost effective. By asking
your doctor to prescribe formulary medications when appropriate and discussing with your doctor the
use of a generic medication, you can help keep your out-of-pocket costs lower while maintaining high-
quality care. The list of formulary drugs can be accessed by clicking the Prescription Drugs link from
the My Benefit Links box.
There are two components to the Prescription Drug Program:


Retail Prescription Drug        Allows you to purchase up to a 30-day supply of medication at
Program                         participating retail pharmacies
Mail-Order Program              A more cost-effective way for you to purchase up to a 90-day supply of
                                maintenance medication by having your prescription drugs sent to you
                                in the mail — and you don’t have to satisfy the deductible first when
                                ordering by mail



Profile: Tony and Sara
Tony and Sara are a young couple who have just started a family with the arrival of their son, Ryan. Tony
works for Tenet, while Sara has a part-time job at a daycare facility. Sara’s employer doesn’t offer
medical or prescription drug benefits to part-time employees, so Tony has elected family coverage in the
PPO. Because he knows they’ll be using brand-name prescriptions on a regular basis for his medical
condition, Tony goes online to model his prescription drug coverage and determines that Rx III is the
most cost effective plan for his family.




Quick Facts

Who You Can Cover               Your coverage category for prescription drugs is determined by your
                                coverage category for your medical plan.
                                You (and your family members) must be enrolled under an HMO or one
                                of the Tenet PPO medical plan options by the date indicated on your
                                Enrollment Worksheet to be covered under the Prescription Drug
                                Program.
Cost of Coverage                Your contribution to the cost of your prescription drug coverage is
                                separate from the premium you pay for medical coverage. Premium
                                information is provided to you during annual enrollment or on your
                                Enrollment Worksheet.
When Coverage Begins            On the 31st day after you begin employment in a full-time or part-time
                                benefit eligible position, provided you’ve enrolled in a Tenet medical
                                plan option by the date indicated on your Enrollment Worksheet.
When Coverage Ends              Your (or your family member’s) coverage under the Prescription Drug
                                Program ends on the earlier of (1) the date you (or your family member)
                                lose(s) coverage under your Tenet medical plan option or (2) the date
                                the Prescription Drug Program is terminated.
                                If you (or your family member) lose(s) coverage under the Medical
                                Program, you (or your family member) may be eligible in some
                                circumstances to continue medical (and therefore, prescription drug)
                                coverage under the Consolidated Omnibus Reconciliation Act of 1985
                                (COBRA), as amended. For more information on COBRA coverage,
                                please see Other Information.
How the Retail Program Works

A Look at the Basics
The Retail Prescription Drug Program, administered by Medco, allows you to purchase up to a 30-
day supply of medication. You simply present your medical identification (ID) card (or prescription
drug card if a separate one is sent) at a participating Medco pharmacy when you have your
prescription filled.

Annual Deductible

If you have a deductible, you must meet it before the plan begins paying benefits.
   Your annual prescription drug deductible depends on your Rx choice.

There is no deductible for Rx I. For Rx III, the deductible is $25 per covered individual. This
deductible is separate from any annual deductible you’re required to satisfy under your medical plan
option. It also applies to EACH covered family member.


Retail Deductible         Rx I                      Rx III
Annual Deductible         $0                        $25 per covered individual




Copays and Coinsurance

Once the applicable deductible is satisfied, the copay or coinsurance for each prescription filled
follows:


Retail Coverage                        Rx I                             Rx III
Generic Drugs                          $5 copay                         $10 copay after deductible
Benefit-Based* Brand-Name Drugs        20% up to a maximum copay        Not covered
Included on the Formulary List         of $75
Brand-Name Drugs Included on           35% up to a maximum copay        $30 copay after deductible
the Formulary List                     of $75
Brand Name Drugs Not Included          50% up to a maximum copay        $45 copay after deductible
on the Formulary List                  of $125
*If you have an ongoing condition for which you take medication — asthma, diabetes, coronary artery
disease (CAD) or congestive heart failure (CHF) — benefit-based drugs offer lower coinsurance for
certain maintenance medications.

If you request a brand-name drug when a generic is available, you’ll pay the generic copay or
coinsurance, plus the cost difference between the brand-name and generic drug. You’ll pay any
deductible amount, copay or coinsurance at the participating pharmacy. As prescriptions for each
family member are filled, the participating pharmacy will track on Medco’s computer system when
covered family members meet their prescription deductible.
Most chain drugstores are participating pharmacies. For assistance in locating a participating
pharmacy near you, click on the Prescription Drugs link in the My Benefit Links box or call Medco
Member Services at 1-800-455-8350. You’ll need your member number (included on your medical ID
card) and ZIP code.


Formulary Drugs Can Save You Money
This cost-saving feature allows your doctor to prescribe appropriate commonly used brand-name
medications, which are more cost effective than other brand-name medications that treat the same
condition. For a list of the brand-name drugs included on the formulary list, click on the Prescription Drugs
link in the My Benefit Links box or call Medco Member Services at 1-800-455-8350.



Save Money by Requesting Generic Drugs
Brand-name drugs often have generic counterparts. Generic drugs have the same active ingredients as
brand-name drugs and are subject to the same FDA standards for quality, strength and purity. Because
generic drugs cost less to produce, it’s more cost effective to use the generic form. The Prescription Drug
Program pays higher benefits for generic drugs than for brand-name drugs. If you request a brand-name
drug when a generic equivalent is available, you’ll pay the generic copay or coinsurance, plus the price
difference between the brand-name and generic drug.
You should always discuss with your doctor or pharmacist whether a generic form of the prescribed drug
exists and is appropriate for you. Unless your doctor has specifically indicated “dispense as written,” the
pharmacist can make the generic substitution upon your request. You should consult with your doctor
regarding the medical implications, if any, of using a generic medication.



Profile: Tony and Sara
When Ryan was six months old, he caught an infection from one of the other children in his daycare
center. Sara received a prescription from his pediatrician and went to fill it at a participating pharmacy.
She was told that the total cost for Ryan’s medication was $70. After Sara showed her medical ID card to
the pharmacist, her prescription benefits were verified on the computer. Then the pharmacist applied
Sara’s prescription benefit to the total cost (see example below). Because this was the first prescription
filled for Ryan this year, he first needed to satisfy his annual prescription drug deductible. Here’s how the
cost for Ryan’s medication was determined:
FOR RYAN’S FIRST PRESCRIPTION ...
Generic prescription drug cost                         $70
Prescription drug deductible for the Rx III plan     - $25
Remaining cost                                         $45   The copay gets applied to the remaining cost.
THE COST FOR RYAN’S FIRST PRESCRIPTION IS ...
Copay                                                  $10   Under the Rx III option, the cost for generic
                                                             drugs is a $10 copay.
Prescription drug deductible for the Rx III plan     + $25
Remaining cost                                         $35   The total cost for Ryan’s first prescription is
                                                             $35 ($25 annual deductible + $10 copay).
After several months, Sara needs to fill another prescription for Ryan. Again, Sara shows her medical ID
card at the participating pharmacy. This time, Ryan’s doctor has prescribed a brand-name medication that
doesn’t have a generic equivalent but is included on the formulary list. The cost of the brand-name drug is
$125.
FOR RYAN’S SECOND PRESCRIPTION …
Brand-name prescription drug cost               $125
Prescription drug deductible (already paid)      - $0
Remaining cost                                  $125
THE COST FOR RYAN’S SECOND                       $30    The cost for brand-name drugs on the formulary
PRESCRIPTION IS …                                       list is a $30 copay.


It Pays to Use Participating Pharmacies
When you use a participating pharmacy, you receive the highest level of benefits. You can also choose
to have your prescriptions filled at non-participating pharmacies; however, non-participating
pharmacies usually charge more than the contracted network rates for prescription drugs charged by
Medco participating pharmacies.

Using Non-Participating Pharmacies
With non-participating pharmacies, you pay the full cost of the prescription at the time of purchase.
For reimbursement, you’ll receive the contracted network cost for a 30-day supply, minus the
appropriate copay or coinsurance. You must complete a claim form to receive reimbursement from
Medco. Be sure to follow all directions on the claim form and attach original receipts. You can get
claim forms by clicking on the Prescription Drugs link in the My Benefit Links box.


How the Mail-Order Program Works
To save even more money, you can use the Mail-Order Program for long-term and maintenance
prescription drugs. It allows you to purchase up to a 90-day supply of generic or brand-name
medications, which are mailed directly to your home. You’ll get a larger supply of medications for
less money than using the Retail Prescription Drug Program.


Mail-Order Coverage                      Rx I                                     Rx III
Annual Deductible                        $0                                       $0
Generic Drugs                            $0                                       $25 copay
Benefit-Based* Brand-Name Drugs          20% up to a maximum copay of $150        Not covered
Included on the Formulary List
Brand-Name Drugs Included on the         35% up to a maximum copay of $150        $63 copay
Formulary List
Brand-Name Drugs Not Included on         50% up to a maximum copay of $250        $100 copay
the Formulary List
*If you have an ongoing condition for which you take medication — asthma, diabetes, coronary artery
disease (CAD) or congestive heart failure (CHF) — benefit-based drugs offer lower coinsurance for
certain maintenance medications.
For example, if a brand-name drug is on the formulary list, and the copay through the Rx III option
is $25 for a 30-day supply, you’ll pay only $63 for a 90-day supply. You’ll get part of your medication
free!


Please Be Aware...
Medco may require that some medications be dispensed through the Mail-Order Program. If your
medication falls into that category, Medco will contact you.

It takes approximately two to three weeks from the time you send in your order form to receive your
prescription drugs in the mail. Order forms for the Mail-Order Program are included in your Medco
information packet. Additional forms can be obtained by clicking on the Prescription Drugs link in
the My Benefit Links box.

If your prescription indicates refills, the mail-order pharmacy will send you a reorder form
with your initial prescription and each subsequent refill. You can then order your refill by mail or
you can call Medco Member Services toll free at 1-800-455-8350. You can also process your refill by
clicking on the Prescription Drugs link in the My Benefit Links box to access the Medco site. Online
orders are usually processed within 7–10 days.

Purchasing Diabetic Supplies Through the Mail-Order Program
If you or a covered family member is diabetic, you can purchase over-the-counter diabetic supplies,*
including lancets and test strips, through the Mail-Order Program. Keep the following in mind when
purchasing these supplies:


Prescriptions Are Required      Your physician needs to write a prescription for over-the-counter
                                diabetic supplies. (Please note that Medco always requires a
                                prescription, even if you live in a state where prescriptions aren’t
                                required for over-the-counter diabetic supplies.)
Prescriptions Need to State     Your doctor needs to indicate the quantity (90-day maximum) and the
the Quantity and the Number     number of refills allowed (if any) on your prescription. If your doctor
of Refills                      doesn’t state the quantity, the pharmacy will send the minimum order,
                                which is one box. Please note that the manufacturers don’t package
                                lancets and test strips in equal numbers.
A Copay or Coinsurance Is       Copays or coinsurance for over-the-counter diabetic supplies are at the
Required for Each Order         brand-name formulary and non-formulary level. For example, with the
                                Rx III option, you will pay $63 per order for formulary or $100 per order
                                for non-formulary (either new prescriptions or refill). Lancets and test
                                strips are considered separate orders; therefore, when ordering both,
                                your total payment with the Rx III option will be $126 for formulary and
                                $200 for non-formulary (two times the formulary or non-formulary cost
                                for each).
It Takes Approximately 2–3      Therefore, be sure you take this timing into consideration when mailing
Weeks to Fill Mail-Order        in your order. If you need an immediate supply, you can purchase a 30-
Prescriptions                   day supply through the Retail Prescription Drug Program at any Medco
                                participating pharmacy. Please note that the Retail Prescription Drug
                                Program also requires a prescription from your doctor, and you’ll be
                                required to satisfy applicable deductibles if you haven’t already. So be
                                sure to get two prescriptions from your doctor.
Refills Are Easy                  If your prescription includes refills, you’ll receive a refill order slip with
                                  your initial order, and with each subsequent order, until all refills have
                                  been sent ― then you can expect to receive a renewal reminder once a
                                  new prescription is needed. Refills can be ordered over the telephone,
                                  by mailing in your refill order slip or online by clicking on the
                                  Prescription Drugs link in the My Benefit Links box to access the Medco
                                  site.
                                  Please note: To cut down on paperwork, members with open home
                                  delivery refills and a history of requesting refills online or by phone will
                                  not receive order forms, business and customer reply envelopes or refill
                                  slips in their home delivery packages. However, they will continue to
                                  receive renewal reminders.
*Subject to formulary guidelines. Please contact Medco at 1-800-455-8350 to see if your supplies are part
of the formulary. If they aren’t, have your physician contact Medco to see if one of the formulary supply
options will work for you.



Profile: Randall
Randall has diabetes and manages his costs carefully. He takes advantage of ordering over-the-counter
diabetic supplies through the Mail-Order Program. He knows he needs separate prescriptions for his
lancets and test strips — and that each of those orders requires a separate copay. That’s why he makes
sure his doctor writes prescriptions for formulary supplies. Under Rx III, Randall pays a total of $126 for
formulary lancets and test strips ($63 per order) instead of $200 for non-formulary supplies.



Pre-Packaged Prescription Drugs
Certain prescription drugs are pre-packaged in supplies greater than the 30-day benefit normally filled
at retail pharmacies. Some drugs are pre-packaged in two-, three-, four- and six-month supplies and
the quantities cannot be cut back.

For pre-packaged drugs filled at retail pharmacies:
    1- to 30-day supplies will be one copay (or appropriate percentage of the total package),
    31- to 60-day supplies will be two copays (or appropriate percentage of the total package),
    61- to 90-day supplies will be three copays (or appropriate percentage of the total package),
    91- to 120-day supplies will be four copays (or appropriate percentage of the total package) and
    so on.

For pre-packaged drugs filled through mail-order:
    91-day or greater supplies will never be charged more than the 90-day copay.


Medco Special Care Pharmacy
The Medco specialty pharmacy service is designed to help you meet the particular needs and
challenges of using certain medications, many of which require injection or special handling.
If you are using a specialty pharmacy medication, you will be eligible to receive additional services
when you fill your specialty prescriptions using the Medco Special Care Pharmacy. These additional
services include:
   Support and guidance from Medco nurses and pharmacists who are trained in these medications,
   their side effects and the conditions they treat
   Expedited delivery of all your specialty prescription medications
   Supplemental supplies, such as needles and syringes that are required to administer the
   medication, at no additional charge
   Scheduling of refills and coordination of services with home care providers, case managers and
   doctors or other healthcare professionals

Days of Therapy Through Medco Special Care Pharmacy
Medications will be dispensed for up to a 90-day supply when appropriate. Certain medications
dispensed through Medco’s Special Care Pharmacy may only be available for up to a 30-day supply
based on dosing, safety, frequent change in therapy or need to minimize waste for that particular
drug. There are other classes of medications that may be limited to a smaller quantity (up to a 30-
day supply) early in your treatment to allow for potential changes in dose. Once therapy has been
stabilized, you will be offered up to a 90-day supply. For example:
   Hemophilia drugs will always be limited to a maximum of a 30-day supply.
   Erythroid stimulants (Epogen®, Aranesp®) and agents for rheumatoid arthritis (Enbrel®,
   Humira®) will be limited to a maximum of a 30-day supply early in treatment.

For those medications that are only limited early in therapy, a Medco Special Care pharmacist will
contact you regarding your past history with the medication to determine whether a larger supply is
appropriate for you.

Your copay will also be automatically adjusted for any medication that has a limited-day supply and
you will not be responsible for a full 90-day copay.

If you have any questions regarding specialty pharmacy medications, please call the Medco Special
Care Pharmacy directly at 1-800-803-2523. Representatives are available Monday through Friday, 8
a.m. to 8 p.m., Eastern Time, to assist you.


Some Medications Require Authorization or
Review
Medco requires a prior authorization or coverage review for certain medications. This applies both
to new prescriptions and to continue coverage on certain medications.
Traditional Prior Authorization (TPA)
The following medications require prior authorization to ensure appropriate coverage decisions
(e.g., patient diagnosis, what the prescribed drug is being used for, recommended dosage, how long
the medication is to be used, possible drug interactions and other safety concerns):
   Accutane/Amnesteem/Sotret
   Alzheimer’s agents (IVRU — Aricept, Exelon, Cognex, Reminyl and Namenda)
   MS agents
   Interferon (alpha, beta, gamma)
   Erythroid stimulants
   Myeloid stimulants
   Platelet proliferation stimulants
   Growth hormones
   Growth hormone receptor antagonist
   IV-immune globulins (e.g., Gammar®, Iveegam®)
   Lupron 1mg
   Synarel
   Pulmozyme
   Regranex
   IVRU – Retin-A/Avita – all dosage forms
   Tazorac – all dosage forms
   Xolair
   Gleevec
   Iressa
   Raptiva
   Zelnorm
   Lotronex for females only
   Synagis/RespiGam
   Provigil
   Amevive
   Zavesca
   Aggrenox through age 49

The list of medications requiring prior authorization is subject to change.

Your doctor should contact Medco Managed Prior Authorization Service at 1-800-753-2851 before
issuing a prescription to you. An MPA pharmacist will discuss the necessary drug criteria with your
doctor before issuing the authorization.
If you don’t receive authorization before picking up your prescription at the pharmacy, your
pharmacist will receive an online message from Medco indicating that prior authorization is necessary
and instruct him or her to contact Medco Managed Prior Authorization Service. This could result in
a delay in receiving your medication.

Smart Prior Authorization (SPA)
Medco automatically tracks each prescription and monitors the standard maximum dosage and
quantities for certain types of drugs. They also review other medications you have taken in the past,
your age and other patient factors. If your doctor has prescribed a medication in excess of the
quantity usually allowed or the usual dose of medication over time, or in cases when evidence of prior
therapy in a step approach is not found, your doctor will need to obtain authorization from Medco
Managed Rx Coverage Service at 1-800-753-2851.

Examples of medications that require authorization and/or quantity limits:
   Migraine medications such as Triptans (Imitrex, Zomig, Amerge, Maxalt), Migranal NS and
   Stadol NS
   Anti-emetics medications such as Zofran, Kytril, Anzemet and Emid
   Ulcer treatment medications such as Zantac, Tagamet, Pepcid, Axid, Prilosec, Prevacid and
   Nexium
   Pain management and arthritis medications such as Toradol, Celebrex and Enbrel
   Relenza limited to a five-day supply or 20 units, whichever is lesser per claim
   Tamiflu limited to a five-day supply or 10 capsules, whichever is lesser per claim
   Tamiflu Liquid limited to a five-day supply or 75ml (three bottles), whichever is lesser per claim
   Anti-fungal medication such as Diflucan and Sporanox
   Sleep agent medication such as Ambien, Sonata, Lunesta and Rozerem
   Chemotherapy medication such as Avastin and Erbitux
   Zonegran and Topamax for patients over age 18 and without prior use of an anticonvulsant
   agent
   Rituxan for patients age 18 and younger and for patients over age 18 without prior use of
   rheumatoid arthritis agent

Preferred Drug Step Therapy
   Hypnotic medication such as Lunesta, Sonata, Rozerem and Ambien CR
   Osteoporosis medication such as Actonel
   Antidepressant (SSRIs) medication such as Lexapro

Retrospective Drug Utilization Review
Medco conducts a Retrospective Drug Utilization Review to identify prescribing, dispensing and
consumption patterns that do not meet the established clinical practice guidelines. Physicians may be
notified about clinical considerations to safeguard patients and manage plan expenses. In some
cases, physicians may initiate changes in therapy.
Dose Optimization Feature
Your prescription drug benefits include a dose optimization feature that identifies opportunities
that can reduce the number of tablets or capsules you must take. If you are taking multiple tablets or
capsules of a lower strength when a higher strength of the same medication is available, your
physician may authorize a higher strength of the medication to be taken less frequently. This process
increases the chances that the medication will be taken correctly and also saves you and the plan
money.

This type of substitution will occur only if your doctor authorizes the change and agrees that a
higher strength of the same medication can be taken once a day. Upon reviewing your home delivery
service prescriptions, Medco will contact your physician to see if a change in dosage is appropriate.
If your physician agrees, you will receive a letter advising you that the doctor has authorized the
change. Medco will also follow up with you by phone.

Prescription Smoking Cessation Medication Review
The Prescription Drug Program covers prescription smoking cessation medications for 180 days of
therapy annually. After the initial 180 days, if your doctor believes that you need an additional supply
of smoking cessation medications before the end of the year, he or she must request a coverage review.
Medco will then contact the doctor to review the prescription to ensure it meets coverage
requirements.


What’s Not Covered by the Prescription Drug
Program

Ineligible Expenses from A to Z
Some prescription drugs and services aren’t available through the Prescription Drug Program.
Ineligible expenses include, but aren’t limited to:
    ADMINISTERING DRUGS: Charges for the administration or injection of any drug
    BIRTH CONTROL DEVICES: Contraceptive devices, jellies, creams, foams, injections and
    implants
    BLOOD PRODUCTS: Immunization agents, biologicals, blood and blood plasma
    ERECTILE DYSFUNCTION DRUGS: Viagra, Cialis, Levitra, Caverject and Muse
    EXPERIMENTAL MEDICATIONS: Experimental or investigational drugs
    FERTILITY MEDICATIONS: Drugs used to treat infertility
    HAIR GROWTH MEDICATION: Drugs used to stimulate hair growth
    INPATIENT MEDICATIONS: Medication that is to be taken by or administered to you or a
    covered family member while a patient is in a licensed hospital, rest home, sanitarium, extended
    care facility, skilled nursing facility, convalescent hospital, nursing home or similar institution
    that has the ability to dispense medications on its premises
   OVER-THE-COUNTER DRUGS AND SUPPLIES: Any medication or supply that
   doesn’t require a prescription, except over-the-counter diabetic supplies
   REFILLS: Refills that are dispensed more than one year from the date of the doctor’s original
   order or that are in excess of the number of refills specified by the doctor
   SMOKING-CESSATION DRUGS: Over-the-counter smoking cessation medications
   THERAPEUTIC DEVICES: Therapeutic devices or appliances, except blood testing
   machines
   VITAMINS: Over-the-counter vitamins, except prenatal vitamins
   WEIGHT GAIN OR LOSS MEDICATIONS: Anorexients or obesity drugs
   WORK-RELATED INJURY MEDICATION: Medication for a work-related injury or
   illness that is covered under Workers’ Compensation, or for which no charge is made

For information regarding eligible prescription drugs, you can call Medco Member
Services at 1-800-455-8350.


How to File a Claim
Whether you need to file a claim depends on whether you go through the Retail Prescription Drug
Program or the Mail-Order Program and whether you use a participating or non-participating
pharmacy. In some situations, you may be required to file a claim. This section outlines the
procedures for both programs.

Retail Prescription Drug Program
Claim forms aren’t required when you use your medical ID card (or prescription drug card if a
separate one is sent) to purchase prescription drugs at participating pharmacies. Simply show your
ID card and pay the required deductible, copay or coinsurance at the time of purchase.

Claim forms will be required, however, if you must purchase prescription drugs before you receive
your medical ID card or you fill a prescription at a non-participating pharmacy after you receive your
medical ID card. You can obtain claim forms by clicking on the Prescription Drugs link in the My
Benefit Links box or by calling Medco Member Services at 1-800-455-8350.

Send the completed claim form to:

Medco Health Solutions, Inc.
P.O. Box 14711
Lexington, KY 40512

Claims must be filed within 12 months after you incur the expense.

Mail-Order Program
With this program, you need to use a Medco Order Form to buy prescription drugs through the
mail. You can obtain claim forms by clicking on the Prescription Drugs link in the My Benefit Links
box or by calling Medco Member Services at 1-800-455-8350.
Send the completed order form to:

Medco
P.O. Box 650322
Dallas, TX 75265-0322

Claims Review and Detailed Description of Claims Process
If you disagree with Medco’s decision regarding a claim, you can have your claim reviewed as
described in Other Information. The Other Information section also describes the claims appeal
process in detail.


Helpful Information About the Tenet
Prescription Drug Program
You can learn additional information about the Prescription Drug Program offered under the TEBP
by reviewing the other sections of this online SPD. THE COMPLETE SPD INCLUDES
INFORMATION ON ELIGIBILITY AND ENROLLMENT, PROCEDURES FOR
APPEALING CLAIM DENIALS, QUALIFIED MEDICAL CHILD SUPPORT ORDERS,
AUTHORITY TO AMEND AND TERMINATE THE TEBP AND ALL OF THE
BENEFIT PROGRAMS (INCLUDING THE PRESCRIPTION DRUG PROGRAM),
COBRA CONTINUATION RIGHTS AND YOUR RIGHTS UNDER THE HEALTH
INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA).

Here’s a list of some quick facts about the Prescription Drug Program you may need to know:


EMPLOYER AND PLAN              Tenet Healthcare Corporation
SPONSOR                        1445 Ross Avenue, Suite 1400
                               Dallas, TX 75202-2703
                               469-893-2000
PLAN ADMINISTRATOR             Tenet Benefits Administration Committee
                               1445 Ross Avenue, Suite 1400
                               Dallas, TX 75202-2703
                               469-893-2000
CLAIMS ADMINISTRATOR           Medco Health Solutions, Inc.
                               P.O. Box 14711
                               Lexington, Kentucky 40512
                               1-800-455-8350
AGENT FOR SERVICE OF           Tenet Healthcare Corporation
LEGAL PROCESS                  1445 Ross Avenue, Suite 1400
                               Dallas, TX 75202-2703
                               469-893-2000
                               Legal process may also be served on the Plan Administrator.
PRESCRIPTION DRUG              The Prescription Drug Program is a component program in the TEBP,
PROGRAM EFFECTIVE              which was originally effective as of October 1, 1977. The Prescription
DATE                           Drug Program became a component program in the TEBP effective as
                               of January 1, 2003.
EMPLOYER                        95-2557091
IDENTIFICATION NUMBER
PLAN NUMBER                     515
PLAN YEAR                       January 1 through December 31
TYPE OF PLAN                    Welfare benefit plan offering prescription drug benefits. See Other
                                Information for more information.


Funding of Benefits
Your benefits under the Prescription Drug Program are funded by your copay and coinsurance
amounts and by premiums paid by you and by Tenet.

Tax Consequences of Participation in the Prescription Drug Program
In general, you may pay for your premiums in the Prescription Drug Program on a pre-tax basis by
reducing your salary. However, premiums for coverage for a domestic partner will be paid on an
after-tax basis, unless your domestic partner also qualifies as your federal tax dependent (determined
without regard to IRC sections 152(b) (1), (b) (2), and (d) (1) (B), which contain certain exceptions
to the definition of dependent and a gross income limitation). The test for determining whether your
domestic partner qualifies as your federal tax dependent may be different than the test for
determining dependent status under the plan. You should consult with your tax advisor to determine
if your domestic partner qualifies as your federal tax dependent. In addition, if you are a highly
compensated employee, there may be certain circumstances in which you are not eligible to exclude
from gross income all or a portion of the premiums or benefits paid under the Prescription Drug
Program. Neither the Plan Administrator nor your employer can guarantee that the benefits
provided to you under the Prescription Drug Program will be excludable from your gross income
for federal and state tax purposes. For more information on the tax consequences of participating in
the Prescription Drug Program, please see your tax advisor.

Your Rights Under ERISA and HIPAA
For a statement explaining your rights under the Employee Retirement Income Security Act of 1974
(ERISA) and HIPAA, see Other Information.


Glossary
Copay or Coinsurance

This is the portion of the prescription costs you’re responsible for paying — under the Prescription
Drug Program, a copay is a flat fee and coinsurance is a percentage of the cost of the drug.

Deductible

The deductible is the amount you need to pay each calendar year before the Prescription Drug
Program begins to cover eligible retail prescription expenses.
Enrollment Worksheet

You use an Enrollment Worksheet to enroll in your Tenet benefits. The Enrollment Worksheet
includes the benefit plans available to you and the premium amounts for each. The Enrollment
Worksheet will be provided to you by the Plan Administrator upon your initial eligibility to
participate and during annual enrollment periods.

Formulary

A key feature of the Prescription Drug Program, a “formulary” is a list of commonly prescribed
medications — both generic and brand name — that have been found to be clinically effective, as
well as cost effective. By asking your doctor to prescribe formulary medications when appropriate,
you can help keep your out-of-pocket costs lower while maintaining high-quality care.

				
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