2022 Beaver Butler Washington MA Kit

Y0069_221001_C Copyright 2021 UPMC Health Plan Inc.All rights reserved. 2022_ENRLRCPWPAPRMLOW_21MCID1940 (MS) 7/2/21 My Prescription Drug Coverage My plan has prescription drug coverage. My current medications are: Medication: Has Limits (circle) _______________________________ Yes * / No _______________________________ Yes * / No _______________________________ Yes * / No _______________________________ Yes * / No UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. * For medications that have limitations, I may need to contact the plan before I can fill my prescription. 140