Prescription Benefit Plan

At the request of SAMBA, Medco manages your prescription drug benefit under the SAMBA Health Benefit Plan (High Option and Standard Option) and the SAMBA Dependent Children Health Benefit Plan (Standard Option only). The benefit includes a list of drugs preferred by your plan. This list, sometimes called a formulary, has a wide selection of generic and brand name medications.

Bring the Preferred Prescriptions^® Formulary Member Guide with you to each doctor visit to discuss whether a drug on the list is right for you. You may purchase the drugs at a retail network pharmacy or through Medco By Mail, Medco's mail-order pharmacy.

To keep your costs low, your copayment will be less when you purchase a generic or formulary brand-name drug. And, if you purchase your drugs through the Medco By Mail, mail-order pharmacy your costs are usually much lower.

Your 2008 Prescription Drug Benefit Handbook

Copayments

HIGH OPTION
Prescription Drugs	Plan Pays: Preferred Provider	Plan Pays: Non-Preferred Provider
Retail pharmacy Rx drugs and medicines – 30-day supply	No deductible 100% after copayment of: $10 per generic $25 per formulary name brand $40 per non-formulary name brand	No deductible 100% after copayment of: $10 per generic $25 per formulary name brand $40 per non-formulary name brand, plus the difference in cost had you used participating plan network pharmacy
Mail order Rx drugs and medicines – 90-day supply	No deductible 100% after copayment of: $10 per generic $5 per generic for Medicare B Primary $45* per formulary name brand $20 per formulary name brand for Medicare B Primary $60* per non-formulary name brand *$35 per non-formulary name brand for Medicare B Primary	Not applicable

STANDARD OPTION
Prescription Drugs	Plan Pays: Preferred Pharmacy	Plan Pays: Non-Preferred Pharmacy
Retail pharmacy Rx drugs and medicines – limited to initial fill, 30-day supply, and one refill	No deductible 100% after copayment of: $10 per generic $30 per formulary name brand $45 per non-formulary name brand	No deductible Reimbursement based on SAMBA's cost of prescription at a participating retail pharmacy
Mail order Rx drugs and medicines – 90-day supply	100% after copayment of: $20 per generic 25% of the Plan allowance ($45 minimum/$80 maximum for each) formulary name brand 25% of the Plan allowance ($60 minimum/$100 maximum for each) non-formulary name brand	Not applicable

Important Reminder about your Secondary Coverage under the SAMBA Plan

When purchasing prescriptions at a participating retail pharmacy, be sure to follow these steps to ensure that you receive the correct coverage:

Show your ID card from your primary insurance carrier and let the pharmacist know that it is your primary coverage.

Show your Medco prescription drug ID card from your SAMBA plan and let the pharmacist know that SAMBA provides your secondary coverage.

The pharmacy’s system will reject coverage of your prescription if you show your SAMBA card first, or if you show only your SAMBA card.

If you have questions, you can call Medco's Member Services toll-free at (800) 283-3478, 24 hours a day, 7 days a week, except Thanksgiving and Christmas, or you can log on to Medco's website at www.medco.com. You can also contact SAMBA's Customer Service toll-free at (800) 638-6589.