University of Medicine & Dentistry of New Jersey

Aetna Pharmacy Management (APM)
Prescription Drug Program
2010-2011 Academic Year

HOW TO FILL A PRESCRIPTION UNTIL YOU RECEIVE YOUR AETNA ID CARD..... Simply pay for your prescription and submit a completed Aetna Prescription Drug Claim Form. Be sure to have the prescription filled at an Aetna Preferred Pharmacy so that you receive the preferred benefit rate. If you have the prescription filled at a Preferred Pharmacy, you will be reimbursed by Aetna in full less the applicable copayment. You can also enroll in Aetna Navigator where you can print a temporary ID card, request a new permanent ID card, check eligibility and claims and much more. Click on www.aetnastudenthealth.com to enroll. Where to find Aetna Preferred Pharmacies Pharmacy locations can be found at: www.aetnastudenthealth.com Click on "Find Your School" and enter 812807 as your Policy number. Additional Pharmacy locations can be obtained by contacting Aetna Pharmacy Management (APM) at (800) 238-6279. Obtaining and filing claim forms An Aetna Prescription Drug claim form can be downloaded from this page or you can obtain a form at your school or by calling APM at (800) 238-6279. When submitting a claim, please include all Prescription receipts with the Aetna Prescription Drug claim form. Indicate that you attend UMDNJ, and include your name, address, and student identification number. Mail your completed claim form and receipts to: Aetna Pharmacy Management Attn: Claim Processing P.O. Box 14024 Lexington, KY 40512-4024 To get a prescription filled that is greater than the 30 day supply.... If you need to get a supply that is greater then the 30 day limit, you may call directly to Aetna Pharmacy Management at 800-238-6279. If the request is approved, please be sure to fill the prescription promptly. You will be responsible for all appropriate copays. (Please note: If you obtain a 3 month supply, you will be charged 3 copays.)

PRESCRIPTION DRUG BENEFIT

Covered Medical Expenses for outpatient Prescription Drugs associated with a covered Sickness or covered Accident occurring during the policy year, are payable as follows:

Preferred Care: 100% of the Negotiated Charge after the applicable per prescription Copay.

Non-Preferred Care: 70% of the Reasonable Charge after the applicable per prescription Deductible.

Per Prescription Copays/Deductibles are as follows:

• $15 for Tier One (Covered Generic medications on the Preferred Drug Formulary List)
• $20 for Tier Two (Covered Brand-Name medications on the Preferred Drug Formulary List)
• $40 for Tier Three (Covered Generic and Brand-Name medications NOT on the Preferred Drug Formulary List)

For information regarding Aetna's Prescription Drug Formulary List, visit www.aetnastudenthealth.com, click on "Find Your School" and enter 812807 as your Policy Number. You can also access the formulary by going to www.aetna.com/formulary and select plan type three tier open formulary.

Please note:

• Covered Medical Expenses for Prescription Drugs are payable up to a maximum of $2,500 per Policy Year
• Please refer to the 2010-2011 UMDNJ Student Health Insurance Plan Brochure for details about your plan's specific pharmacy benefits
• The Formulary List is subject to change as of January 1, 2011.

Medications not covered by this benefit include, but are not limited to: drugs whose sole purpose is to promote or to stimulate hair growth, appetite suppressants, smoking deterrents, immunization agents and vaccines, and non-self injectables.

Prior authorization is required for growth hormones and drugs which are used in the treatment of Malaria.

The following list is intended to provide you with a summary of the Prescription Drug Benefit provided under the 2010/2011 UMDNJ Student Health Insurance Plan, and is not intended as a guarantee of benefits. For assistance, or for a complete list of excluded medications or drugs available with prior authorization, please contact Aetna Customer Service at (800) 238-6279.