Major Medical Health Insurance

Transcription

1 Major Medical Health Insurance Available to Association Members and their Familes Underwritten by: American Republic Insurance Company, Des Moines, Iowa

2 CAREAdvantage COMPLETE is a health plan that represents one of the most extensive selections of coverage and premium choices available to you and your family. Designed with today s healthcare consumer in mind, CAREAdvantage COMPLETE provides numerous benefit options allowing you to build your own plan. The Premium $aver Options offer benefit choices that can reduce your overall premium to meet your individual budget. Also, you can elect to avoid annual rate increases by locking in the premium you choose for up to 36 months. You can feel confident that after reviewing the plan features and benefits with your agent, you will have selected a plan that meets your health insurance needs at a price you can afford. Rated A- (Excellent) by A.M. Best and with more than 75 years in the insurance business, American Republic Insurance Company is committed to their long-standing tradition of caring about those they have the privilege to serve. Based on providing ethical and reliable service to customers, the tradition of caring is the foundation that has helped American Republic to become The Care Company. American Republic s mission of providing customers with high-quality individual health insurance protection that preserves the customer s freedom of choice is also part of their tradition. These are the driving principles that allow American Republic to nurture and maintain long-term relationships with customers. You Pay Deductible Choices In-Network: q $1,000 q $2,000 q $2,500 q $3,500 q $5,000 q $7,500 q $10,000 Out-of-Network: 3 times In-Network Deductible chosen In-network calendar year deductible apply to each person. When 3 family members have each satisfied the in-network deductible during a calendar year, the in-network deductible for any other covered family member will be waived for eligible in-network expenses for the remainder of that year. A separate family maximum of three out-of-network deductibles applies. Coinsurance Choices Then You Pay CoinIn-Network q 0% (Plan pays 100% of eligible expenses) q 25% of the next $10,000 of eligible expenses q 50% of the next $10,000 of eligible expenses Out-of-Network 20% of the next $10,000 of eligible expenses 50% of the next $10,000 of eligible expenses 50% of the next $20,000 of eligible expenses Coinsurance is the portion of eligible expenses up to the specified limit above each person s deductible that you pay. CAREAdvantage COMPLETE pays 100% of eligible expenses after coinsurance is met. Eligible expenses are the usual and customary amount allowed by the Company for covered services by providers in the same locality. For in-network expenses, the actual negotiated amount agreed upon with the network is considered the usual and customary allowance. There is a family coinsurance maximum of 3 times the individual coinsurance amount each calendar year (separate maximum for in- and out-of-network). Copays and outpatient prescription drug expenses do not count toward satisfying the basic deductible and coinsurance amounts.

3 Doctor Office Visits and Services $40 Copay per Dr. Office Visit $20 Copay per Laboratory Test $40 Copay per X-Ray The Doctor Office Visit Copay covers the in-network office visit charge, and any drugs, surgical procedures, or miscellaneous charges associated with that office visit (from the same provider and incurred on the same day). Routine physical exams and allergy tests are not covered under this benefit. Separate copays apply for lab tests and x-rays. These services must be performed in a doctor s office. Office visits and services from out-of-network providers are not covered under the this benefit. Out-of-network Doctor Office Visits and Services are covered subject to the out-of-network deductible and coinsurance. Outpatient Prescription Drug Benefit Generic - No Deductible $20 Retail Copay; $50 Mail Order Brand - $500 Deductible $50 Retail Copay; $125 Mail Order Under this benefit, eligible expenses include up to a 34-day supply of a prescription drug dispensed by a retail pharmacy, up to a 90-day supply dispensed by mail-order pharmacy, and up to three vials of one type of insulin or 100 disposable insulin syringes (not to exceed a 34-day supply). Eligible expenses include contraceptive drugs or devices. Certain prescription drugs require authorization prior to purchase. Your participating pharmacist will assist in obtaining authorization when necessary. A calendar-year maximum is not applicable on this benefit, unless a Premium $aver Option has been selected or an Outpatient Calendar Year Maximum has been chosen. Benefits are subject to the Lifetime Maximum. The maximum family deductible for brand name drugs is three times the individual amount. Lifetime Maximum $5,000,000 per insured person Specific maximums may apply for certain conditions. Rate Guarantee Initial 36-Month Rate Guarantee Your premiums will not increase for at least 36 months from your coverage issue date, so long as your area of residence, benefit selections and covered persons remain the same. Premium $aver Options $40 Copay per Dr. Office Visit $20 Copay per Lab Test* $40 Copay per X-Ray* Maximum benefit of $500 per person, per calendar year. * Must be performed in doctor s office. $50 per Visit Indemnity Maximum of three visits per person, per calendar year. Pays up to the benefit amount for eligible expenses in or out-of-network. Premium $aver Options Generic & Brand $2,000 Calendar Year Limit per insured person Generic Drugs Only No Deductible $20 Retail Copay/$50 Mail Order Generic Drugs Only $2,000 Calendar Year Limit No Deductble $20 Retail Copay/$50 Mail Order Prescription Discount Card Express Scripts Generic and brand name drugs are purchased by insured using available discounts. Premium $aver Option $2,000,000 per insured person Selecting this option reduces premium by lowering the plan s lifetime maximum. Premium $aver Options 30-Month rate guarantee 24-Month rate guarantee 18-Month rate guarantee 12-Month rate guarantee To reduce premium you can select one of the above rate guarantee options.

4 Benefits Outpatient Calendar Year Maximum (Optional) These options apply to all covered outpatient expenses per person and reduces premium by limiting the policies calendar year liability. Calendar Year Maximum (Optional) These options apply to all covered inpatient and outpatient expenses per person and reduces premium by capping the policy s calendar year liability. Premium $aver Options $25,000 per insured person $15,000 per insured person $7,500 per insured person Premium $aver Options $300,000 per insured person $200,000 per insured person $100,000 per insured person Preventive Care $40 Copay per visit (In-Network or Out-of-Network) Plan pays balance of eligible expenses up to the coverage year maximum per insured: 1st year: $100 2nd year: $150 3rd year & after: $200 Coverage Year Covered services include routine physicals, immunizations and preventive screening procedures. Maternity Benefit (Optional) Benefit Per Unit $250 $375 $500 Accident Benefit (Optional) q $500 or q $1,000 # Units Selected q The Maternity benefit provides coverage to help pay expenses associated with a normal pregnancy, childbirth, and newborn hospital expenses. Up to eight units of coverage can be purchased. The benefit per unit is $250 in coverage year 1, $375 in coverage year 2 and $500 in coverage years 3 and after. Benefits are determined by the coverage year in which the pregnancy ends. You cannot be pregnant at time of application. The Maternity option is available (in most states) to eligible females ages 17 through 39. Pays first-dollar benefits for covered injuries. Benefits are payable in or out-of-network for eligible expenses incurred within 90 days of the accident. Eligible expenses that exceed the benefit maximum or that are incurred after 90 days are subject to plan provisions. Important Plan Features Discount for Preferred Risks A 10% premium discount is available for those individuals who apply and are accepted for coverage as Preferred. Consult your agent for guidelines. Continuation for Children Your children may remain on the coverage as long as you wish -- no age or full-time student requirements. Common Accident Deductible When more than one person incurs eligible expenses due to the same accident, only one basic deductible applies. Emergency Treatment Any emergency treatment received outside the network is covered at the preferred provider in-network level. If medically necessary treatment is not available within the network and you are referred by a preferred provider to an out-of-network provider, benefits will be provided at the preferred provider level. Newborn Coverage Your children are covered immediately at birth for 31 days. Within this 31-day period, newborns may be added to the coverage by notifying the Company and paying an additional premium.

5 CAREAdvantage COMPLETE covers eligible expenses for covered services that are medically necessary for the treatment of an injury or sickness, subject to coverage provisions. Eligible expenses are the usual and customary amount allowed by the Company for covered services for providers in the same locality. For in-network expenses, the actual negotiated amount agreed upon with the network is considered the usual and customary allowance. These expenses are covered under all CAREAdvantage COMPLETE plans, subject to coverage provisions. Inpatient Hospital 1, Surgical, and Medical Expenses Semiprivate hospital room and board and general nursing care expenses. Hospital intensive care confinement. Medical diagnosis, treatment and surgery by a doctor. Anesthesiologist s service for a covered surgery. Miscellaneous services, supplies, durable medical equipment, and oxygen and any equipment needed for its use. Reconstructive breast surgery following a mastectomy. Laboratory tests, x-rays and radiology. Physical, speech or occupational therapy, sports medicine. pulmonary or cardiac rehabilitation therapy. Radiation therapy, chemotherapy and related supplies. Prescription drugs and medicines administered while a hospital inpatient. Alcoholism treatment. Outpatient Services Observation room expense. Medical diagnosis, treatment and surgery by a doctor. For manipulative therapy, includes up to 10 outpatient visits for any services, supplies or treatments. Anesthesiologist s service in a doctor s office for a covered outpatient surgery. Outpatient miscellaneous services and supplies. Outpatient prescription drugs. Includes contraceptives, drugs and devices dispensed through a hospital s outpatient department, an outpatient surgical center, a doctor s office, or a retail pharmacy. 2 Reconstructive breast surgery following a mastectomy. Outpatient laboratory tests, x-rays and radiology, including CAT scans and MRIs. Services are not limited to a hospital stay or surgery. Diabetes care and treatment. Mammography, cervical cancer, prostate cancer and colorectal cancer screening tests, as provided by the plan. Chemotherapy, radiation therapy, and hemodialysis. Outpatient physical medicine, including physical, speech or occupational therapy, sports medicine, pulmonary or cardiac rehabilitation therapy. Durable medical equipment used on an outpatient basis. 1 Hospital does not include a nursing home, convalescent home, extended care facility or a clinic. 2 Not applicable if Generic Only or Discount Prescription Card Premium $aver Option selected. Emergency Treatment Emergency care and services in an emergency room department of a hospital (subject to the Emergency Room Copayment), doctor s office, surgical center or urgent care center. Ambulance Expenses Professional ambulance service to the nearest hospital providing the necessary care. Human Organ or Tissue Transplant or Replacement Expenses Bone marrow, heart, lung, kidney, cornea, pancreatic/islet, or intestinal transplants, including pre- and post-transplant services, as well as donor expenses. If services are not provided by a Center of Excellence or preferred provider, coverage is limited to one transplant per calendar year for a covered person, up to maximum of $100,000. Skilled Nursing Facility Confinement Expense Skilled nursing facility expenses up to one-half the semiprivate hospital room rate for up to 30 days per calendar year (following a hospital stay, as provided by the plan). Home Health Care or Nursing Service Visit Expense Home health care or nursing visits up to 40 visits per calendar year. Hospice Care Expenses, as provided by the plan TMJ and CMD Expenses Temporomandibular joint dysfunction (TMJ) or craniomandibular joint dysfunction (CMD) expenses up to $2,500 lifetime. Nonsurgical treatment is limited to diagnostic examination and x-rays, muscle relaxants or therapeutic drug injections, and physical, diathermy or ultrasound therapy. Alternative Care or Treatment Plan Company-approved, cost-effective health care services not otherwise considered eligible. This brochure provides a description of some of the important features of your plan. The benefits, exclusions and limitations listed are typical, but your state may have slight differences. Please see the state insert (if applicable) or consult your agent for details. The policy and your certificate are the contract and set forth in detail the rights and obligations of both you and the Company. This plan is not being sold as an employee benefit plan. For further details about this or other available coverage, please contact your agent or American Republic Insurance Company.

6 PPO Network Providers The CAREAdvantage COMPLETE plan gives you access to preferred provider organization (PPO) hospitals and doctors in your selected network and participating pharmacies in our pharmacy network. When you choose participating providers, you receive the maximum benefits from your coverage and take advantage of negotiated rates for covered services that are usually less than the rates normally charged by the network provider. When covered services or supplies are received from a PP0 network provider, the actual agreed-upon price charged by the provider is considered the usual and customary allowance for eligible expenses. If you use providers outside the PPO network you may have additional expenses to pay if the amount charged by the provider is more than the usual and customary amount allowed by the Company for the same or comparable service or supplies for other providers in the same locality. The provider can bill you for the balance of charges over and above what your coverage allows. The Company reserves the right to change the preferred provider network. Emergency Room Copay (Per person per visit) A $150 copay must first be satisfied (applied before the basic deductible) when services, supplies and treatment are received through a hospital emergency room. The emergency room copay is waived if admitted as a hospital inpatient within 24 hours. Preauthorization Preauthorization is required prior to inpatient and outpatient surgeries, outpatient physical medicine, or any scheduled hospital or skilled nursing stay, home health or hospice care, home infusion, or transplants or replacements. Authorization is not required before treatment in an emergency situation; however, a later authorization is required. For human organ or bone marrow transplants or replacements, authorization is required at the time your doctor first indicates a transplant or replacement may be needed. The purpose of preauthorization is to evaluate medical necessity of proposed treatment, as defined in the coverage. The final decision about the treatment you receive is between you and your doctor. Preauthorization does not guarantee that benefits will be paid. Payment of benefits will be determined by the terms of your coverage. Benefits may be reduced or denied if preauthorization procedures are not followed or treatment is unauthorized. Coordination of Benefits Benefits may be reduced if you have other coverage or become eligible for Medicare. The order of benefit determination rules in the certificate explain whether the benefits of this coverage are determined before or after those of the other coverage. Premiums and Renewability All applications are individually underwritten. Initial premium rates are guaranteed for 36 months 3 from coverage effective date so long as your area of residence, benefit selections and covered persons remain unchanged. Your benefits and premiums will vary depending on plan, coverage choices and each optional benefit selected. We reserve the right to change premium rates on any renewal date after coverage has been in effect for 36 consecutive months 3. The total premium you pay each year for your coverage may vary depending on the mode (frequency of payments) and method you select for premium payment. Should a premium change be necessary in the future, it will only be made if made on all forms in the same rate class as determined by us and not on an individual basis. At most ages, the premium will increase because a covered person is one year older. You may renew coverage for any covered person by paying the premiums as they come due. A 31-day grace period is allowed for payment of your premium. We may decline to renew the certificate or any one or more benefit endorsement: (a) if we decline to renew all other forms of the same class as yours issued to everyone in the state, (b) for any fraudulent misstatements on your personal application or any fraudulent claim. The Outpatient Prescription Drug Benefit may also be nonrenewed if the Company s contract with the prescription card administrator ends or is terminated. We may change benefits under the coverage or any deductible, coinsurance, copayment or maximum of the coverage. Such changes may be made on a renewal date or at the beginning of a calendar year and will only be made by class, not on an individual basis. 3 Unless a Premium $aver Option is selected Preexisting Conditions This coverage is designed to pay for accidents that occur or sickness that first manifests itself after the date of issue. We will not pay for a preexisting condition or disease that is not admitted on the application for up to two years after issue. Preexisting condition means the existence of symptoms within a 12-month period before the date coverage begins that would cause an ordinarily prudent person to seek diagnosis, care or treatment, or a condition for which medical advice was given or treatment has been recommended or received within a 24-month period before the effective date of coverage. Preexisting conditions fully disclosed on the application are covered unless excluded by name or specific description. Any false statement, misrepresentation or omission in the application may result in benefits being denied or the contract being rescinded, subject to the Time Limit on Certain Defenses. (Provisions may vary by state.)

7 EXCLUSIONS AND LIMITATIONS This coverage, including all endorsements, does not cover loss which results from: any treatment that is not medically necessary, or charges for which benefits are not specifically provided; any complications arising from any medical procedure or condition not covered as an eligible expense; outpatient medical services, including doctor office visits and diagnostic testing, unless specifically provided outpatient physical medicine, including physical, chiropractic/ manipulative, speech or occupational therapy, sports medicine, pulmonary or cardiac rehabilitation therapy, unless specifically provided; durable medical or home care equipment, oxygen and equipment needed for its use, and medical services and supplies, unless specifically provided; rest cures, custodial care or routine physical exams, except as; alternative medicine including but not limited to acupressure, acupuncture, homeopathy, hypnotism, massage therapy, aroma therapy, and rolfing; mental or nervous disorders and any complications, except as specifically provided; alcohol or drug abuse and any complications, except as specifically provided; childbirth, pregnancy (except for complications of pregnancy) or routine newborn care, unless specifically provided; sexual dysfunction, including but not limited to sex transformations, penile implants, or any complications; treatment for infertility or any complications; sterilization (sterilization due to covered injury or sickness is covered after one year); outpatient prescription drugs and medicines, unless specifically provided; growth hormone therapy; dental care or surgery; temporomandibular joint dysfunction (TMJ) or craniomandibular joint dysfunction (CMD), except as provided; cosmetic surgery for any complications, except for certain reconstructive surgery; breast reduction or augmentation; weight modification programs or surgical treatment of obesity; eyeglasses, contact lenses, or hearing aids and examinations for prescription or fitting thereof, eye exercises, or visual training or treatment of myopia or hyperopia; foot inserts, orthopedic shoes or supportive devices for the feet; suicide, attempted suicide, or intentionally self-inflicted injury; wigs or scalp-hair prosthesis; any services, supplies or treatment covered under any federal, state, or any other government plan or law, except Medicaid; the amount Medicare provides for eligible expenses; care in a convalescent home or a convalescent, rest, or nursing facility, or custodial or education facility, or a facility for the aged, except as specifically provided; any services, supplies or treatments received outside the United States or its possessions, unless incurred while on a trip of less than 60 days in duration; any services performed by a family member; services, supplies, or treatment for which no charge is normally made in the absence of insurance, except Medicaid; war; experimental or investigational treatments; intoxication or being under the influence of a narcotic, unless taken on advice of a physician; or any loss resulting from taking part in organized contests of speed, or from parachuting, or from use of any aircraft (including ultralight aircraft) except as a fare paying passenger on any commercial aircraft, or from participating in rodeo activities, or by climbing; committing or attempting to commit a felony or engaging in an illegal occupation. The Outpatient Prescription Drug Benefit (unless the Prescription Discount Card Premium $aver Option is selected) does not cover: drugs not covered by the drug formulary; over a 34-day supply per prescription from a retail pharmacy, a 90-day supply from mail-order, or the drug manufacturer s recommendation; infertility drugs or medicines; durable medical equipment; over-the-counter medications; compounded drugs not containing at least one legend ingredient, unit-dose drugs, dietary supplements, or vitamins; prescription refills exceeding the doctor s prescription order or dispensed more than one year after the original prescription date; experimental or investigational drugs; drugs covered by a Workers Compensation or Occupational Disease Law; immunization agents, biological sera, blood or blood plasma; drugs for cosmetic purposes (including Retin-A) or treatment of hair loss; drugs prescribed for care, services or treatment not provided under the plan or for treatment of any sickness or injury not covered by the plan; drugs used for the purpose of weight loss or treatment of sexual dysfunction; drugs containing nicotine or its derivatives, or smoking cessation drugs; DDAVP or other drugs used for treatment of bed-wetting (under age six); any drug not consistent with the diagnosis and treatment of a sickness or injury or excessive in terms of the scope, duration or intensity of drug therapy needed; convenience drugs; or drugs prescribed for conditions or diseases excluded by name or specific description under the plan.

8 For more information contact: PBG

9 NORTH CAROLINA NO RECOVERY FOR PRE-EXISTING CONDITIONS-READ CAREFULLY. Unless excluded, no benefit will be provided during the first 12 months coverage for any disease or physical condition not admitted on the application which existed within 12 months prior to the effective date of your coverage under this certificate. This provision does not apply to newborn, foster or adopted children. The benefits and/or provisions stated below are those which differ from provisions described in the sales material and may not include all mandated state provisions. 1. THE OPTIONAL MATERNITY BENEFIT IS NOT AVAILABLE IN NORTH CAROLINA. 2. DEDUCTIBLE CHOICES The Out-of-Network Deductible amount is 2 x the In-Network amount 3. ELIGIBLE EXPENSES The following are considered eligible expenses under this coverage: A. Inpatient Hospital, Surgical and Medical Expenses: Inpatient hospital, surgical and medical benefits are limited to the following eligible expenses: Reconstructive breast surgery following a mastectomy. We will provide benefits for reconstruction of the breast on which the mastectomy has been performed as well as surgery and reconstruction of the nondiseased breast to produce a symmetrical appearance. We will also pay for prostheses and coverage of physical complications at all stages of a mastectomy, including lymphedemas. Reconstruction of the nipple/areolar complex following a mastectomy will be covered without regard to the lapse of time between the mastectomy and reconstructions, subject to your doctor's approval. Prescription drugs and medicines administered while an inpatient in a hospital or a nursing facility. We will not pay for drugs which are not approved for general use by the Federal Drug Administration. We will not deny benefits for any FDA approved drug used while a hospital inpatient for the treatment of a specific type of cancer for which it has not been approved, if the drug is recognized as safe and effective for treatment of such cancer in any of the following standard reference compendia: (1) The American Medical Association Drug Evaluations; (2) The American Hospital Formulary Service Drug Information; or (3) The United States Pharmacopoeia Dispensing Information. B. Human Organ or Tissue Transplant or Replacement Expenses: We will provide benefits up to the lifetime transplant and replacement maximum of $500, for each covered person when transplant services are provided by a preferred provider or a Center of Excellence. Eligible expenses for a covered human organ or tissue transplant or replacement will include: pre-transplant evaluation services, the transplant procedure and related hospital services, post-transplant care, and other services related to the transplant. Any eligible expenses incurred by a donor will be considered as if incurred by the covered person.

10 If you do not use a Center of Excellence or transplant services are obtained from a nonparticipating provider, the transplant benefit will be limited to one transplant per calendar year for a covered person. Benefits for such transplant services will limited to a lifetime maximum of $250, for each covered person, which applies toward the lifetime transplant and replacement maximum. Only those human organ transplants or tissue transplants or replacements listed below will be considered eligible under this coverage: heart, or lung, or heart/lung transplants; liver transplants; kidney transplants; pancreatic/islet transplants; intestinal transplants; cornea transplants; and bone marrow transplants. 4. PREAUTHORIZATION Preauthorization in NOT required in NC. 5. EXCLUSIONS AND LIMITATIONS We will not pay benefits for: Growth hormone therapy, except when prescribed for treatment of congenital defects or anomalies of normal growth and development; Cosmetic surgery including any complications thereof, except for an emergency medical condition for which coverage will be provided until the covered person is stabilized. This includes, but is not limited to, injection vein therapy for spider veins. We will pay benefits for reconstructive surgery expenses incurred. Such service must be due to an injury which occurs or an infection or other disease of the involved part which is first manifested while this coverage is in force. We will pay benefits for reconstructive surgery if it is required to correct a functional defect caused by a congenital disease or anomaly of a newborn, adopted or foster child while such child is covered under this coverage and this coverage is in force; 6. PREEXISTING CONDITIONS We will not pay for preexisting conditions, diseases or illnesses which are first manifested prior to the effective date of coverage, subject to the TIME LIMIT ON CERTAIN DEFENSES provision. In no case will we pay for other conditions, diseases or illnesses which are excluded by name or specific description. However, if a condition, disease or illness is first manifested prior to the date of the application, and is admitted on the application, we will pay for the condition, disease or illness, unless excluded by name or specific description. A PRE-EXISTING CONDITION is a health condition for which medical advice, diagnosis, care or treatment was recommended by or received from a physician within a 12 month period before the effective date of the coverage of a covered person. This includes any condition or disease which is first manifested after your application is completed and prior to the effective date of your coverage.

11 Pregnancy will not be considered a pre-existing condition. Genetic information will not be considered a pre-existing condition when the covered person has not been diagnosed with a medical condition related to this information. This preexisting condition limitation will not apply to covered newborn, adopted or foster children. If a covered person enters active military service, that person will not be covered during that service. We will refund any premium we accepted for that person during such service. 7. OUTPATIENT CALENDAR YEAR MAXIMUM This limitation does not apply to eligible expenses incurred for state mandated benefits. 8. CALENDAR YEAR MAXIMUM BENEFIT This limitation does not apply to eligible expenses incurred for state mandated benefits. The following section applies to CAREAdvantage EQUITY only. 1. OUT-OF-NETWORK COINSURANCE Individual Plans 0% In-Network Plan: Out-of-network coinsurance is 20% of the next $10,000 of eligible expenses 25% In-Network Plan: Out-of-network coinsurance is 50% of the next $10,000 of eligible expenses Family Plans 0% In-Network Plan: Out-of-network coinsurance is 20% of the next $20,000 of eligible expenses 25% In-Network Plan: Out-of-network coinsurance is 50% of the next $20,000 of eligible expenses 2. PREVENTIVE CARE (OPTIONAL) During the waiting period, eligible expenses incurred for mammograms, pap smears, prostate cancer screenings and ovarian cancer screenings will be considered eligible expenses as listed in the certificate, and will be subject to the deductible and coinsurance amounts. The following section applies to CAREAdvantage COMPLETE only. 1. OUTPATIENT PRESCRIPTION DRUG BENEFIT Exclusions and Limitations We will not pay for: Contraceptive drugs known as RU-486 or any equivalent drug product and Preven or any equivalent drug product; 2. DOCTOR OFFICE VISITS AND SERVICES Doctor office visits and services from nonparticipating providers are not eligible under this endorsement and will be processed under the coverage to which this endorsement is attached, and will be subject to all deductible, coinsurance and other requirements and limitations found in the coverage. PBG-1081 NC