Off-Campus In Network
These benefits apply to the current plan year (2012-2013), which ends on August 25th, 2013.
Benefits are provided through Express Scripts (ESI), a point-of-service provider, if you are enrolled in the student injury and sickness insurance
plan. Please call 1-888-201-5853 for questions regarding benefits or network participating pharmacies. If an Insured Person incurs prescription
claims within the first 4 weeks of the semester before eligibility is loaded with the insurance carrier, the Insured Person must pay for the prescription
and submit a claim to Express Scripts after the 4th week at:
Express Scripts
P.O. Box 66583
St. Louis, MO 63166-6583
Attn: STD Accts
Group Rx #AM2A
After 4 weeks, the Covered Person may go to any network pharmacy with their SHIP/ESI Card (see printing instructions below). Moscow campus SHIP
students may obtain prescriptions off-campus using their SHIP/ESI card if the prescription is written for a one time filling with a 30 days or less supply or if a
prescription is not available at the On-Campus Student Health Pharmacy. This limitation does not apply to UI Centers students.
| GENERIC | BRAND NAME | NON-FORMULARY |
|---|---|---|
| Co-payment $15 | Co-payment $30 | Co-payment $60 |
When a generic medication is available and you choose to purchase a brand name drug, even when the doctor writes “dispense as written” or “may not substitute”, you must pay the cost difference between the brand name prescription and the generic prescription, in addition to your co-insurance.
If you purchase your prescription medications from a non-participating pharmacy, you will have to pay the full price of the prescription and then submit a claim to the claims administrator, AmeriBen, for reimbursement (see page 2).
The Insured Individual may present their SHIP/ESI card to go to any participating pharmacy or utilize the Express Scripts Home Delivery Program. The following co-payments apply:
|
NETWORK PHARMACY |
EXPRESS SCRIPTS HOME DELIVERY 90 DAYS |
|
|---|---|---|
| Generic Drug | $15 | $45 |
| Formulary Drug | $30 | $90 |
| Non-Formulary Drug | $60 | $180 |
Proof of Insurance Card
The Student Health Insurance Program does not send health insurance cards unless requested. A proof of insurance card will be e-mailed to your official University e-mail account when requested through the link at www.health.uidaho.edu/SHIP
Express Scripts Claim Form
Express Scripts Formulary (Drug Coverage List)
Express Scripts In-Network Providers - Idaho
Express Scripts In-Network Providers - Washington
Express Scripts Out-of-Network Providers - National