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Proving What’s Possible in Healthcare <br />This document contains important terms and conditions which are incorporated by reference into and becomes <br />part of the terms of your contract with us. ©2024, Healthcare Management Administrators, Inc. <br />20 <br />Additional Fees <br />File Fees <br />Description Price <br />Refill Transfers $4,5000.00 for 1 test file and two production files <br />$1,500.00 for separate pre transition file. <br />Prior Authorization $3,500.00 <br />Claims History $2,500.00 12 months worth of data <br />Account Balances $2,500.00 <br />Historical Claims Experience <br />Transactions/CET data <br />Previous 24-month period: $125.00 per month up to $3,000.00 <br />After 24-month period: $1,250.00 per quarter, $5,000.00 per year <br />Fees may apply for standard on-going <br />claim files for additional vendor file <br />feeds <br />Quoted upon request <br />Communication Fees <br />(Fees only apply when Participating Group opts into or requests outreach to their members.) <br />Description Price <br />Negative formulary change letters, Pharmacy termination service, network <br />disruption, Notice of Creditable Coverage (NOCC), and other mailings in <br />black/white up to 4 pages. <br />$1.35 per letter plus postage <br />Other mailings, including color, 5+ pages, custom letters, payroll stuffers, etc..Quoted upon request <br />All member communications sent digitally –(except for ID cards which are <br />included at no cost)$0.75 per letter <br />Pharmacy Benefits <br />Additional Fees as follows are for clients on our contract and <br />are effective January 2025 –December 2025.* <br />*Please Note: <br />•Other fees, terms and conditions apply –please see the CVS/Caremark Add’l Fees, Pricing, Terms & Condition section. <br />•Please see Participating Group Agreement and supplement documents for full Terms and Conditions.