2026 CODAC Benefit Summaries and Carrier Flyers

MEDICINE or MEDICATION The term "Medicine or Medication" (or "Drug") means a substance or preparation that alleviates or treats an Illness or Injury and may be available by Prescription only, or over-the-counter (OTC). Medicines and Medications include only substances and preparations that qualify as medical care under Section 213 of the Internal Revenue Code. In general, medical care means care for the diagnosis, cure, mitigation, treatment, or prevention of disease or for the purpose of affecting any structure or function of the body. NETWORK PHARMACY A Network Pharmacy is a Pharmacy that has entered into an agreement with the PBM, or an organization contracting on its behalf, to provide Prescription Drugs to Participants, which has agreed to accept specified reimbursement rates for dispensing Prescription Drugs; and has been designated by your PBM as a Network Pharmacy. Some PBMs may not apply a Network or have open Networks. See the PBM's information and website for more information. NON-NETWORK PHARMACY Any Pharmacy that is not in any designated Network is a Non-Network Pharmacy and the PBM will provide any rules and restrictions on the use of a Non-Network Pharmacy. When a Pharmacy is a Non-Network Pharmacy, there may be no reimbursement, or the PBM will pay out at a UCR or predominant reimbursement rate as the PBM determines in its sole and absolute discretion. The PBM may reimburse you after you have fully paid the amount. See also Exhibits A and C for any rules. NON-PREFERRED MEDICATION The Term "Non-Preferred Medication" means medication not included on any Formulary or list of preferred prescriptions under this Prescription Drug Plan. Non-Preferred Medications often have higher Co-Payments or Co Insurance than preferred Medications. NON-PRESCRIPTION MEDICATION The term "Non-prescription Medication" means an over-the-counter (OTC) Medication or supply, normally purchased without a prescription and which is pre-packaged for use by the consumer and labeled in accordance with the requirement, statutes, and regulations of federal and applicable state governmental authorities. ORPHAN DISEASE The term "Orphan Disease" means a condition that affects fewer than 200,000 people nationwide. This includes diseases as familiar as cystic fibrosis, Lou Gehrig's disease, and Tourette's syndrome, and as unfamiliar as Hamburger disease, Job syndrome, and acromegaly, or "gigantism." ORPHAN DRUG The term "Orphan Drug" means a pharmaceutical agent that has been developed specifically to treat an Orphan Disease or other rare medical condition, and for purposes of this definition, the drug must also be included on the PBM Specialty Drug List. There are some drugs that are designated as an "Orphan Drug" but are not included on the PBM Specialty Drug List and are therefore excluded from the Plan. OUT-OF-POCKET The term "Out-of-Pocket" means the amount of expenses, including Deductibles, Co-Payment and Co-Insurances that are the responsibility of the Covered Person and that accumulate towards the Rx Plan's Out-of-Pocket Maximum, which is the amount listed in Exhibit A, not including amounts for: A. expenses that are not covered under this Plan; B. in excess of the UCR for a Prescription Medication, service or supply; C. in excess of any maximum benefit listed in the Plan; or D. attributable to any penalty, including any Dispense as Written penalty.

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