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Detailed Table of Contents |
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| Index | |
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Introduction
Who Is Eligible
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Enrolling for Coverage
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Program Premium Cost
| Determining an Annual Premium for You and Your Spouse/Domestic Partner |
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Your Rights and Responsibilities
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How the Retiree Group Health Program Works
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| Retiree Group Health Program Design – Mental Health and Substance Abuse Program |
| A Summary Chart of the Retiree Group Health Program – CIGNA Open Access Plus |
| A Summary Chart of the Retiree Group Health Program – CIGNA Indemnity |
| A Summary Chart of the Retiree Group Health Program – CIGNA Post-65 Medicare |
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| What Is an Expense That May Be a Covered Expense – Medical Program |
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| What Expense is Excluded From Being a Covered Expense – Medical Program |
| What Is an Expense That May Be a Covered Expense – Mental Health and Substance Abuse Program |
| What Expense is Excluded From Being a Covered Expense – Mental Health and Substance Abuse Program |
How the Prescription Drug Program Works
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| What Is an Expense That May Be a Covered Expense – Prescription Drug Program |
| What Expense Is Excluded From Being a Covered Expense – Prescription Drug Program |
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| How to Fill Your Prescriptions through the Mail Service Pharmacy |
Your Legal Right to Continuation Coverage
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Coordinating Benefits With Other Programs
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How to File a Claim
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ERISA Claims and Appeals Procedures
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Situations Affecting Your Benefits
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| Right to Reimbursement, Assignment of Rights, and Duty to Notify |
Administrative and Contact Information
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Special Rules for Certain Participants
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| Wallace, Litho, Nielsen Retiree Group (retired on or after January 1, 2004) |
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| Skilled Nursing Facility/Inpatient Rehabilitation Facility Services |
| Spinal Treatment, Chiropractic, and Osteopathic Manipulative Therapy |
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| Experimental or Investigational Services or Unproven Services |
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Your ERISA Rights
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Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - Moore Wallace
Who Is Eligible
Domestic Partner Eligibility Requirements
A domestic partner (your same- or opposite-sex domestic partner) includes any individual with whom you have been residing in the same residence for at least 12 months. For your domestic partner to be eligible for dependent coverage as if the dependent partner were to qualify as a spouse, both you and your domestic partner must:
 | Meet all of the requirements applicable to a spouse; |
| Be at least 18 years old; |
| Not be legally married to or the legal domestic partner of anyone else; |
| Intend to remain each other’s sole domestic partner indefinitely; |
| Live together in the same principal residence and intend to do so indefinitely; |
| Be emotionally committed to each other and share joint responsibilities for your common welfare and financial obligations; and |
| Not be related by blood, closer than would prohibit marriage in the state in which you live. |
In addition, you must be eligible for retiree coverage and your domestic partner must qualify as such on your termination date.
You also may be required to prove your interdependence (if requested). You can do so by providing two of the following documents:
| Common ownership of real property; |
| Common ownership of a motor vehicle; |
| Drivers’ licenses that list a common address; |
| Proof of joint bank accounts or credit accounts; |
| Proof of designation as the primary beneficiary for life insurance or primary beneficiary under a partner’s will; or |
| Assignment of a property power of attorney or health care power of attorney. |
