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Prescription Drug Card |
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Use
Under normal circumstances, when you use your pay-direct drug
card to purchase prescription medicines, you pay only the
Member's share at time of purchase and no claim form is
needed. Rarely, you may find that the pharmacy is not able to
process your prescription using your pay-direct drug card due
to technical difficulties with the pay-direct computer system or the fact that the pharmacy
doesn't participate in the drug card program. In these rare
cases you may have to pay the full amount for your
prescription and file a claim for reimbursement.
Use the Extended
Health Benefits Claim Form form if you've paid for prescription drug
purchases that would normally be covered when using your
pay-direct drug card and you wish to be
reimbursed. |
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Information Needed to Complete the Form
Your personal Member information and the Group Plan number (9000) is
needed to complete the form. in addition:
- original receipts,
- the name of the insured person(s),
- the relationship of the employee,
- birth date(s),
- information about other insurance
plans that you may be eligible to claim from,
- If you are coordinating claim's payment
with your spouse's health plan, you should
include the primary carrier's payment statement.
Please follow the instructions on the form.
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Notes
Questions on completing the form should be directed to the
Plan Administrator.
Completed forms should be forwarded directly to DA Townley.
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Plan Administrator
Millworkers Health & Welfare Plan (Unifor) Administrator
c/o D.A. Townley
4250 Canada Way
Burnaby, BC, V5G 4W6
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email: Health
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