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Benefits not specifically listed as provided
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Charges above usual and customary or reasonable (UCR) charges. Cash purchases at CVS Caremark pharmacies will be reimbursed at plan rates
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Drugs administered in a physician's office. However, services may be covered by your medical plan (See Medical for details.)
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Drugs for male or female baldness
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Drugs for obesity and weight control
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Experimental or investigational drugs, or drugs dispensed for studies or trials
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FDA-approved drugs dispensed or administered for non-FDA approved uses
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Fees for writing prescriptions or filling out claim forms
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Immunization agents, blood, blood plasma or biological sera
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Oxygen
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Professional provider charges for administering drugs
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Services or supplies for which no charge is made
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Services or supplies for which you could have received payment (in whole or part) under any government program or law if you had applied
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Services or supplies for which your employer is required to provide benefits under workers' compensation, liability or other law, even if you waive your right to those benefits
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Services or supplies you receive before your coverage begins or after it ends
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Take-home drugs dispensed when a member is a patient in a facility such as a hospital — not covered by the Prescription Drug Plan though often covered by a medical plan (See Medical for details.)
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Vitamins — not covered, even if prescribed.
