Accidental injury — A bodily injury to a covered person that is caused solely by external, violent and accidental means and results directly in a covered expense, independently of other causes. Intentionally self-inflicted injuries are not covered.

Amalgamated Transit Union (ATU) — The collective bargaining agreement you work under that governs your eligibility to participate in the Trust. (See Participating in the Plans — Eligibility for details.)

Brand name drug — A drug marketed under a trademark name, usually created by the manufacturer that holds the patent on the drug. A brand name drug cannot be distributed by another manufacturer (for example, as a generic drug) until the patent expires.

Calendar year — Each year, January 1 through December 31.

Claims administrator —The Trust Office.

Collective bargaining agreement — A collectively bargained agreement between the District and a labor organization that requires contributions to the Trust.

Copayment — The dollar amount you must pay upon receipt of services or supplies covered by the plan.

Covered person — An employee of the District or a dependent of the employee who meets the plan's eligibility and enrollment requirements.

Dependent — The spouse or domestic partner of a covered employee or any unmarried child of the employee, spouse or domestic partner who meets the plan's eligibility requirements.

District — School District No. 1, Multnomah County, Oregon.

District Council of Unions (DCU) — The collective bargaining agreement you work under that governs your eligibility to participate in the Trust. (See Participating in the Plans — Eligibility for details).

Employee — Any person employed by School District No. 1, Multnomah County, Oregon, who is eligible to participate in the plan.

Generic drug — A drug that is chemically and therapeutically equivalent to a brand name drug whose patent has expired. Generic drugs are typically less expensive than their brand name counterparts and are sold under the drugs' common names.

Illness — A condition, disease, ailment or bodily disorder (other than an injury and pregnancy), or physical disorder that causes functional impairment. Illness does not include any state of mental health or mental disorder (which is otherwise defined in this handbook).

Injury — Physical damage to the body inflicted by a foreign object, force, temperature or corrosive chemical or that is the direct result of an accident, independent of illness or any other cause. Injury does not mean bodily injury caused by routine or normal body movements such as stooping, twisting, bending or chewing and does not include any condition related to pregnancy.

Nonparticipating pharmacy — A retail pharmacy not participating in the CVS Caremark retail pharmacy network.

Non-VSP provider — Any optometrist, optician, ophthalmologist or other licensed and qualified vision care provider who has not contracted with VSP to provide vision care services and/or vision care materials to covered persons of VSP.

Option 1 — The Trust Plan for eligible full-time and part-time employees and their eligible dependents (part-time employees have a choice of Option 1 or Option 2). Option 1 includes medical, prescription drug, dental, vision, disability, life and survivor benefits.

Option 2 — The Trust Plan for eligible part-time employees and their eligible dependents (part-time employees have a choice of Full-Time/Part-Time Option 1 or Part-Time Option 2). Part-Time Option 2 includes medical and prescription drug benefits.

Participating pharmacy — A retail pharmacy participating in the CVS Caremark retail pharmacy network.

Pharmacist — A person who is licensed to prepare and dispense drugs.

Plan — The School District No. 1 Health and Welfare Trust Prescription Drug Plan described in this document

Plan (from Vision) — The School District No. 1 Health and Welfare Trust Vision Plan described in this document.

Plan (from Dental) — The School District No. 1 Health and Welfare Trust Dental Plan described in this document.

Plan administrator — The administrator retained by the Board of Trustees to administer the plan under the Board's direction and control. Administrative duties include (but are not limited to) maintaining eligibility records and processing claims.

Plan document (from Prescription Drugs) — The written Trust Prescription Drug Plan document.

Plan document (from Vision) — The written Trust Vision Plan document.

Plan document (from Dental) — The written Trust Dental Plan document.

Plan year (2016) — February 1 to December 31.

Plan year (2017) — January 1 to December 31.

Portland Federation of School Professionals (PFSP) — The collective bargaining agreement you work under that governs your eligibility to participate in the Trust. (See Participating in the Plans — Eligibility for details).

Preauthorization — Prior authorization needed from the prescribing physician before certain prescriptions will be filled by a retail pharmacy or the mail order service. Preauthorization may be required due to the specific drug, the supply size or dosage, or the timing of the prescription or refill.

Prescription — A written order for dispensing and administering a drug, signed by a professional provider who is licensed to prescribe drugs.

Prescription drugs — Medicines, drugs or supplies that are used for the treatment of illness or injury and cannot be legally dispensed without a written prescription.

Refill — The continuation of an original prescription, as authorized by the prescribing professional provider.

Trust — The School District No. 1 Health and Welfare Trust.

Trust agreement — The Trust Agreement of the School District No. 1 Health and Welfare Trust Fund and any valid amendments.

Usual and customary or reasonable (UCR) rates (from Dental) — The fees and prices regularly charged by your dentist and other dentists in your area for the dental services and supplies generally furnished for cases like yours.

Usual and customary or reasonable (UCR) rates (from Vision) — The rates charged for a given vision service or supply by similar providers in your geographic area.

VSP preferred provider — An optometrist or ophthalmologist licensed and qualified to practice vision care and/or provide eyewear who has contracted with VSP to provide vision care services and/or eyewear to VSP members.

Visually necessary or appropriate — Services and materials medically or visually necessary to restore or maintain a patient's visual acuity and health and for which there is no less expensive professionally acceptable alternative, as determined by VSP.