The Empire Plan shall also include basic medical coverage to
provide benefits when non-participating providers are used. These benefits will
be paid directly to enrollees according to reasonable and customary charges and
will be subject to deductible, co-insurance, and calendar year and lifetime
maximums. Effective July 1, 2008,
the reasonable and customary allowance for pharmaceutical products charged to
the basic medical component of the Plan will be the lesser of the actual charge
for the covered pharmaceutical product or the average price charged by
wholesale distributors/pharmaceutical manufacturers to doctors, pharmacies and
infusion companies