2026 CODAC Benefit Summaries and Carrier Flyers

COVERED DRUG, MEDICINE OR SUPPLY A Covered Drug, Medicine or Supply is any Prescription Drug or Prescription Medicine, related supplies, other pharmaceutical products, services or supplies dispensed by a Pharmacy to a Participant for which coverage is provided in accordance with this Program and which are Covered and payable under the terms of this Rx Plan. See Section 4.3,

Rx Plan Benefit Information. COVERED EXPENSES

The term "Covered Expenses" means expenses incurred by a Covered Person for any Medically Necessary Drugs or Medications that are not specifically excluded from coverage elsewhere in this Plan, or other charges which are specifically listed as covered under this Rx Plan. COVERED PERSON A Covered Person is an eligible Employee who is participating in the Rx Plan and their Spouse and/or eligible Dependents also covered by the Rx Plan, in accordance with the terms of the Rx Plan. Covered Persons are also referred to as "you" or "Participant" within this document. CUSTOMARY See "Usual, Customary and Reasonable" below. DEDUCTIBLE The term "Deductible" means the amount a Covered Person must pay before any benefits will be paid by the Prescription Drug Plan, unless the Deductible is specifically waived. The Deductible applies to the Out-of-Pocket Maximum under the Prescription Drug Plan. DENIAL The term "Denial" means the adverse determination of a Prior Authorization request or a submitted Claim. DISPENSE AS WRITTEN Dispense As Written is an order by the Prescriber that is to be followed and generally involves dispensing a Brand name Drug when a Generic Drug is available. If you or your Prescriber chooses not to substitute a Generic Drug for the Brand-name Drug, you may have to pay an additional amount, and/or you may be charged the Brand-name Co Insurance or Co-Payment amount, but only receive credit on the deductible for the generic Co-Insurance or Co Payment amount. Any special rules for Dispense as Written are stated in Exhibit A. DISPENSING FEE Dispensing Fee is a fee charged by a Pharmacy to cover costs associated with dispensing a medication. DRUG "Drug" refers to a prescription drug or medication. See "Medication" below. DRUG LIST A "Drug List" or "Formulary" or "Formulary Medication" all mean a Medication or Drug or other pharmaceutical product, service or supply set forth on a Formulary Drug List (or just "Drug List") provided by the PBM. This list is updated and revised by the PBM from time to time under the terms of this Rx Plan to include new drugs, generic equivalents and drugs removed from the market or made available over the counter. A current version of the Drug List or Formulary may be found at the PBM's website as indicated in the PBM Data Sheet and is the listing of Drugs and Medications and related services that are generally covered.

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CIDN:199534