Eligibility: Active members, retired continuation of benefits (Retiree Plan) & COBRA status members only. Benefit: Reimbursement is up to $60.00 each prescription co-payment, up to $800. After the $800 has been reached, an additional $ 2.00 per prescription will be calculated in. The benefit is for eligible members and dependents. The deadline to submit a claim is April 30, 2023.

Prescription Claim Form 2022.pdf