Eligibility Requirements:

You are not eligible for the Healthy Savings Program if any part of your prescription is covered by:

1. any federal or state healthcare program (Medicare, Medicaid, VA, TriCare, etc.), including state medical or pharmaceutical assistance programs;
2. the Medicare Prescription Drug Program (Part D), or if you are currently in the coverage gap;
3. insurance is paying for the entire cost of your prescription, or;
4. an insurer or other Third Payor in Massachusetts.

Terms & Conditions

You must meet Eligibility Requirements. You agree to report your use of this card to any Third Party that reimburses you or pays for any part of the prescription price. You additionally agree that you will not submit the cost of any portion of the product dispensed pursuant to this card to a federal or state healthcare program for purposes of counting it toward your out-of-pocket expenses (such as TrOOP under Medicare Part D). The amount of this card/offer is not to exceed $35 or your co-pay amount, whichever is less. Offer Expires 12/31/10. This offer may be rescinded, revoked, or amended without notice. No reproductions. This card is void where prohibited by law, taxed, or restricted. Limit one card per patient and up to 12 uses. Cash value of 1/100 of 1¢.