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Pay
Card

Prescription drug
card program

Nationwide The Rx Pay Card prescription drug card program does not
acceptance require a health questionnaire and may be used at over
55,000 participating pharmacies throughout the United States.
With more than For a full list of prescriptions and to find pharmacies that
55,000 participating accept the Rx Pay Card, visit www.advancedrugcard.com.

pharmacies The Rx Pay Card program has the following tiers:

Tier 1 – Generic drugs
Up to $10 per prescription

Tier 2 – Brand name and select generic drugs
Up to $20 per prescription

Tier 3 – Brand name and select generic drugs
Up to $50 per prescription

Tier 4 – Brand name drugs
Discount only

Please note: Not all FDA-approved generic, preferred or
brand name drugs are included in tiers 1, 2, 3 or 4. A complete
list of all drugs included in this program can be found at
www.advancedrugcard.com. Drug pricing and tier position are
subject to change without notice. Tier position and pricing are
only for quantities stated; additional quantities may result in
higher cost.

THIS PROGRAM IS NOT INSURANCE. This Discount Prescription Drug Card Program is not insurance coverage and does not meet the minimum essential coverage requirements
under the Affordable Care Act (ACA). Enrolling in and maintaining this plan will not exempt you from the shared responsibility payment (tax) that may apply if you do not have a plan
with ACA-compliant coverage.

The brochure provides a brief description of the Rx Pay Card and the Discount Prescription Drug Program. The program may not include all drugs. This plan provides discounts
at certain pharmacies for certain prescriptions. The drug list is subject to additions or deletions without notice. The range of discounts will vary depending on the pharmacy and
prescription drug. The program does not make payments directly to the participating pharmacies. Program members are obligated to pay for 100 percent of the purchase price of all
prescription drugs but will receive a discount from participating pharmacies that have contracted with the program. A program member has the right to cancel membership within
the first 30 days after the effective date of the Rx Pay Card and receive a full refund, less a nominal processing fee. VOID WHERE PROHIBITED BY LAW. The program and
its administrators shall have no liability for providing or guaranteeing service by participating pharmacies or for the quality of service rendered by participating pharmacies.

THIS IS NOT A MEDICARE PRESCRIPTION DRUG PLAN, but applies to MD residents when pharmacy discounts are part of program. This program does not meet the minimum
creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. The discounts offered through the use of the Rx Pay Card are not insurance and are not intended as a
substitute for insurance.

This product is jointly administered by The Loomis Company (Loomis) and EnvisionSavings.

Brochure RX Pay Card L 0318 1
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