The mail order form will provide the address to which you will send: your mail order form, an original written prescription from your doctor and pre-payment by check, money order or credit card.

If a credit card is used, refills can be ordered by calling Caremark Customer Service or by visiting their website at www.caremark.com. If a check or money order is used, refills can be ordered with an order form. Please allow 14 days from the date you mail your order form for delivery of your medication.

A generic equivalent will be substituted for certain brand name drugs whenever allowed by your doctor and applicable pharmacy law. If you do not want a generic substitution for a specific medication, please note in the “Comments” section on the order form.

Your Health and Safety are Important:
When you use a participating retail pharmacy or the mail service, the pharmacist’s expertise, the information provided by your physician, and your prior prescription history through the plan are combined to process your prescription. Real-time, point-ofservice alerts, when indicated, are sent to your pharmacist on potential concerns regarding how your prescription may interact with other medications you are currently taking, your disease state, your age, etc. The alerts supplement your pharmacist’s professional evaluation, assisting the pharmacist to determine whether follow-up action with you and/or your doctor is necessary before dispensing the prescription.

Disclosure. This plan is NOT insurance. This is not a Medicare prescription drug plan. The plan provides discounts at certain health care providers for medical services. The plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. This plan is administered by Coverdell & Company, Inc., a discount medical plan organization at 8420 W. Bryn Mawr, Suite 700, Chicago, IL 60631, 1-800-308-0374. You have the right to cancel this plan within 30 days of the effective date for a full refund of fees paid.

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