RxSimpleShare Prescription Drug Program is included in the Healthy Life EasyShare Programs.
RxSimpleShare allows for the purchase of many common prescriptions for a $5 co-share. See section IX
for details. Other prescription drugs are only eligible for sharing when provided by a Hospital as part of
inpatient treatment or provided by a Facility during an outpatient surgical procedure.:
(ab) PSA Test.
PSA tests are eligible for sharing once every two years up to and including age forty-nine (49). PSA tests
are eligible for sharing for members fifty (50) years of age and older once each year.
(ac) Respiratory Therapy.
N/A
(ad) Speech Therapy/Speech Pathology.
N/A
(ae) Vision Therapy.
N/A
(af) Well Baby Visits.
Well baby visits, including immunizations, are eligible for sharing within the first year of birth.
(ag) Well Child Exam.
See Annual Routine Physical Exam, above.
(ah) X-Ray.
For X-Rays in a non-hospital environment EasyShare limits sharing to a fixed amount of $250 per
visit/series with the member responsible for any amount above that limit. All outpatient X-Ray imaging
have a 90-day waiting period, are sharable only with a physician prescription and must be procured at a
free standing in-network diagnostic center unless received as an admitted patient.
ii. Sharing for Physical Conditions; Illnesses and Injuries.
Expenses for most types of physical conditions resulting from Illness or Injury are generally sharable,
subject to all applicable conditions and limitations set forth elsewhere in these Guidelines, although
special provisions apply for certain conditions, as explained below:
(a) Abortion in Specific Circumstances.
Services, supplies, care or treatment in connection with an abortion may only be sharable if (a) the
physical life of the mother is endangered by the continued Pregnancy and treatment via a cesarean
section has been determined by a neonatologist to be inadvisable, or (b) the Pregnancy was the result of
a rape or incest for which a police report was filed.UHFR093021E100121 Page 111
(b) Asthma.
Asthma is generally sharable, but during the first 36 months membership, a Confirmation of No Prior
Existence of Condition statement may be required.
(c) Back Problems.
Back problems are generally sharable, but during the first 36 months membership, a Confirmation of No
Prior Existence of Condition statement may be required.
(d) Bunions.
Bunions are generally sharable, but during the first 36 months membership, a Confirmation of No Prior
Existence of Condition statement may be required.
(e) Cancer.
Generally sharable, but limitations may apply if it is related to cancer of a type you had prior to becoming
a Member (see Section 4.05(n)) and during the first 60 months membership, a Confirmation of No Prior
Existence of Condition statement may be requ