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Introduction
Eligibility
Health and Welfare Plan Benefits: Medical Plan
Health and Welfare Plan Benefits: Medical Plan
What You Should Know Before You Receive Care
Service Area
Deductibles, Coinsurance and Co-Pays
Deductible
Coinsurance
Co-Pay
Out-of-Network Services with Out-of-Pocket Met
Out-of-Pocket Maximum
Lifetime Maximum Benefits
Emergency Admissions
Utilization Management Requirements
Pre-Admission Review
Concurrent Review and Discharge Planning
Post-Payment Review
Maternity Admissions
Second Surgical Opinion
Home Health Care
Individual Case Management
Disease State Management
How to Appeal a Utilization Management Decision
Inpatient Mental Health and Substance Abuse Utilization
Medical Plan Benefit Chart
Federal Laws That May Affect Your Medical Benefits
Health Insurance Portability and Accountability Act (HIPAA)
Newborns’ and Mothers’ Health Protection Act
Uniformed Services Employment and Reemployment Rights Act of 1994
Women’s Health and Cancer Rights Act
Mental Health Parity Act of 1996 (MHPA)
What the Medical Plan Does Not Cover
Prescription Drug Program
Hearing Plan
Dental Plan
Vision Plan
Continuing Your Coverage (COBRA)
HIPAA Pre-Existing Condition Disclosures
Qualified Medical Child Support Orders (QMCSOs)
Weekly Accident and Sickness Benefits (Loss of Time)
Life Insurance Plan
Accidental Death and Dismemberment Insurance (AD&D) Plan
Medical and Dental Plan Coordination of Benefits
How to File Claims and Appeal Denied Claims
Important Terms
The Plan and Your Privacy
Plan Administrative Information
Your ERISA Rights
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