GapPlusPlan.com for UBA Members

409 W VICKERY BLVD, FORT WORTH, TX 76104 | 866.438.4274

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Get Insured for Prescriptions
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Gap RX Plan

Member Driven Value.

Plan Costs

$40 per month - Individuals
$80 per month - Family  

Gap RX Plan - $10 Generic Copay Card

Summary of Plan

Why Gap RX Plan

Save On Prescriptions - Go Generic
Don't Let the Cost of Prescriptions Get Away From You



Did You Know

Generic Drugs have for several decades offered relief from rising prescription drug costs.1

  • With increased availability and utilization of lower cost generic versions of branded drugs, patients now have the tools to find the saving they need.

  • Research shows that generics work just as well as brand name drugs.2


There is an 80-85% less average cost difference of generic drug vs its brand-name counterpart.2
All FDA-Approved Generic Drugs must be equivalent to the brand-name drug.
2

Stats taken from:
1ASPE Issue Brief, Understanding Recent Trends to Generic Drug Prices, January 27, 2016. Department of Health & Human Services: https://aspe.hhs.gov/system/files/pdf/175071/GenericsDrugPaperr.pdf.
2Facts about Generic Drugs Infographic from the FDA: https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingGenericDrugs/ucs305896.htm.
Generic Retail Copay Prescription Insurance

MAXIMUM BENEFITS

 Annual Deductible per Covered Member  $0
 Maximum Benefits Payable Per Member Per Month  $300



GENERIC COPAY AMOUNT
$10


The information is a brief description of the important features of this insurance plan and provided for information purposes only. It is not an insurance contract nor is it an invitation to offer to contract. Insurance benefits are issued by Envision Insurance Company. PRAM Insurance Services, Inc. is the exclusive underwriter for Envision Insurance Company. Coverage may not be available in all states or certain terms may be different when required by state law. See policy documents for a complete description of benefits, exclusions, limitations, and conditions of coverage. Envision Insurance Company does not provide nor is affiliated with the discount programs provided as part of membership in the United Business Association. Information is subject to change.



Your overall total association membership dues include these insurance rates:
Individual: $23.68  | Individual + Spouse: $44.99  | Individual + Child(ren): $41.44  | Family: $54.46

Note: The Gap RX Plan CANNOT be combined or used with MailMyPrescriptions.com membership benefit in your UBA Membership Benefits and Services.
What To Do at the Pharmacy

What to Do with Your Gap RX ID Card

Present Your ID Card to Pharmacy
Pharmacy Processes Claim
Pay Generic $10 Copay at Time of Service
RX Id Card Sample


*RxEDO is the prescription benefit manager whom processes your prescription claims. RxEDO uses many of the same pharmacies, preferred drugs, and services that you are already accustomed to. If your pharmacy has questions concerning the process, please have them call the RxEDO Pharmacy Help Desk at the number listed in your Member Guide or on your Gap RX ID Card. To locate a provider use the link located in your guide or call RxEDO's Member Services Department at the number listed in your guide.

Covered Items

Prescription Drugs

All Outpatient3 Medically Necessary Legend non-injectable medications shown in the Formulary, unless otherwise specifically excluded, and any of the following.


  Family Planning
  
  • Oral Contraceptives


  •   Nutritional Products
      
  • Prenatal Legend Vitamins


  •   Other Legend Drugs
      
  • Prenatal Legend Vitamins
  •   
  • Acne Products (retin-A, up to 24th Birthday)
  •   
  • Compounds (one ingredient must be legend)
  •   
  • Cough & Cold
  •   
  • Immunosuppressants



  • 3Outpatient means Prescription Drug is not taken in, or administered by, a hospital or any other health care facility or office.

    All over-the-counter & injectable medications are excluded unless listed as a covered item. If classifications contain both prescribed and over-the-counter or both injectable and non-injectable, prescribed products will be covered unless shown above.

    State Availability

    Gap RX Plan is Available in the Following States:

    AL, AR, AZ, DE, DC, FL, GA, IL, IN, IA, KY, LA, MI, MS, MO, NE, ND, OK, PA, SC, TX, VA, WV & WY.

    View Gap RX Sample Guide

    Click on Link below to View Gap RX Plan Sample Member Guide

    Click here to view Gap RX Plan Sample Member Guide

    Group Insurance Certificates

    Click on State Image to View Group Insurance Certificates.

    Alabama Gap RX Group Insurance Certificates
    Alabama

    Arkansas Gap RX Group Insurance Certificates
    Arkansas

    Arizona Gap RX Group Insurance Certificates
    Arizona

    District of Columbia Gap RX Group Insurance Certificates
    DC

    Delaware Gap RX Group Insurance Certificates
    Delaware

    Florida Gap RX Group Insurance Certificates
    Florida

    Georgia Gap RX Group Insurance Certificates
    Georgia

    Illinois Gap RX Group Insurance Certificates
    Illinois

    Indiana Gap RX Group Insurance Certificates
    Indiana

    Iowa Gap RX Group Insurance Certificates
    Iowa

    Kentucky Gap RX Group Insurance Certificates
    Kentucky

    Louisiana Gap RX Group Insurance Certificates
    Louisiana

    Michigan Gap RX Group Insurance Certificates
    Michigan

    Mississippi Gap RX Group Insurance Certificates
    Mississippi

    Missouri Gap RX Group Insurance Certificates
    Missouri

    Nebraska Gap RX Group Insurance Certificates
    Nebraska

    North Dakota Gap RX Group Insurance Certificates
    N. Dakota

    Oklahoma Gap RX Group Insurance Certificate
    Oklahoma

    Pennsylvania Gap RX Group Insurance Certificate
    Pennsylvania

    Texas Gap RX Group Insurance Certificate
    Texas

    Virginia Gap RX Group Insurance Certificates
    Virginia

    West Virginia Gap RX Group Insurance Certificates
    West Virginia

    Wyoming Gap RX Group Insurance Certificates
    Wyoming

    Exclusions & Limitations

    For Generic Copay Prescription Insurance

    1. All over-the-counter products and medications unless shown under the definition of Prescription Drug and specifically prescribed by a medical provider. This includes, but is not limited to, electrolyte replacement, infant formulas, miscellaneous nutritional supplements and all other over-the-counter products and medications.

    2. Blood glucose meters; insulin injecting devices, other than insulin syringes.

    3. Depo-Provera; Condoms, contraceptive sponges, and spermicides; sexual dysfunction drugs.

    4. Biologicals (including allergy tests); blood products; growth hormones; hemophiliac factors; MS injectables; immunizations; all other injectables unless shown under the definition of Prescription Drug.

    5. All other medical supplies and durable medical equipment unless shown under the definition of Prescription Drug.

    6. Liquid nutritional supplements; pediatric Legend Drug vitamins; prescribed versions of Vitamins A, D, K, B12, Folic Acid and Niacin - used in treatment versus as a dietary supplement; all other Legend Drug vitamins and nutritional supplements.

    7. Anorexiants; Any cosmetic drugs including, but not limited to, Renova, skin pigmentation preps; any drugs or products used for the treatment of baldness; Topical dental fluorides.

    8. Refills in excess of that specified by the prescribing Physician; or refills dispensed after one year from the original date of the prescription.

    9. Brand Name Prescription Drugs.

    10. Any drug labeled “Caution - limited by Federal Law for Investigational Use” or experimental Drugs.

    11. Any drug which the Food and Drug Administration has determined to be contraindicated for the specific treatment.

    12. Drugs needed due to conditions caused, directly or indirectly by an Insured Person taking part in a riot or other civil disorder; or the Insured Person taking part in the commission of a felony.

    13. Drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or an act of war; or drugs dispensed to an Insured Person while on active duty in any armed force.

    14. Any expenses related to the administration of any drug.

    15. Drugs or medicines taken while in or administered by a hospital or any other health care facility or office.

    16. Drugs covered under Workers Compensation, Medicare, Medicaid, or other Governmental program.

    17. Diaphragms; Erectile dysfunction Legend drugs, unless specifically listed in the definition of Prescription Drugs; Infertility Legend drugs

    18. Epi-Pen, Epi-Pen Jr., Ana-Kit, Ana-Guard; Glucagon-auto injection; Imitrex-auto injection.

    19. Smoking deterrents, Legend or over-the-counter.

    20. Vacation supplies and replacement of lost, stolen, spilled, broken or dropped Prescription Drugs.

    21. All newly marketed pharmaceuticals or currently marketed pharmaceuticals with a new FDA approved indication for a period of one year from such FDA Approval for its intended indication.

    Claims Information

    For Claims Assistance, Contact:

    United Business Association
    RxEDO Pharmacy Help Desk: 800.522.7487
    RxEDO Member Services Dept: 888.879.7336


    Benefit payment is subject to the Policy plan provisions, limitations, exclusions and other provisions within the Certificate. There is no retail copay or coverage for Brand Name Drugs. For more information and complete details of terms, conditions, limitations, exclusions of coverage, please refer to the Certificate. Coverage may vary and may not be available in all states. A copy of the Certificate is available from the Association upon request. Members present your I.D. card and your prescription to a participating pharmacy to receive benefits under your plan. At the time of service, you must pay the copay as required by the plan. Your I.D. card is for identification purposes only and it is not a guarantee of coverage.

    Terms & Disclaimers

    Disclosures

    If insurance is included in any Gap Plan, it is not basic health insurance or major medical coverage and does not qualify as minimum essential coverage under the Affordable Care Act. You must be a member of the United Business Association (UBA) to access and enroll in any Gap Plan that provides an insured benefit. Various insurance companies, as described, have issued group limited benefit insurance policies to the United Business Association as the group master policyholder. You must purchase UBA Membership in order to purchase this additional plan.



    UBA Refund / Cancellation Policy

    If you are not completely satisfied with your UBA Membership Gap Plan, please call your Personal Member Concierge at 866.438.4274. We will be happy to issue a complete refund of membership dues within the first thirty (30) days. We want you to be 100% satisfied with your UBA Gap benefits and services.

    Note: This membership is separate from any other insurance or supplemental plan you have purchased. Please contact your agent for any plans other than the UBA Gap Membership Plan. If you are canceling, please make sure to cancel using our cancellation phone number at 866.438.4274 or our cancellation form located at gapplusplan.com/billing.html. Please do not cancel through your agent. Cancel directly with GAP to make sure your cancellation request is handled promptly and correctly.

    30 Day Money Back Guarantee
    Family Planning - like Oral Contraceptives
    Nutritional Products - Prenatal Vitamins
    Other Legend Drugs like Cough Medicine, Acne Products and more.
    Gap RX Plan