Summary Plan Description

Diabetic Care

90% Network and 80% Non-Network

Benefits are provided for an approved diabetic training program prescribed by a physician, including education, training, meal planning (although not the cost of meals), and treatment and prevention of hyperglycemia or hypoglycemia. Coverage is also provided for diabetic supplies including injection aids and blood glucose monitors. If your physician prescribes a home blood glucose monitor, you may purchase the monitor from a pharmacist and submit the pharmacy receipt with the completed claim form to Carpenters Trusts. Home blood glucose monitors cannot be processed through the prescription drug programs.

If you are diabetic and not eligible for Medicare, you must purchase insulin, syringes, blood glucose testing strips, and lancets through one of the prescription drug programs – the Express Scripts Retail Pharmacy Program or Express Scripts By Mail. Prescriptive agents for controlling blood sugar levels must also be purchased through one of the prescription drug programs. If you purchase these items from a nonparticipating pharmacy or other diabetic supplier, you must pay full retail price and submit a Prescription Drug Reimbursement Form to Express Scripts. Express Scripts will reimburse you at 100 percent of the "average wholesale price" – the program's discounted price – less the appropriate copayment.