Retiree Eligibility Requirements

Benefits-Eligible Position

General Information

Enrolling Yourself and Your Spouse/Domestic Partner

Eligible Surviving Spouse/Domestic Partner’s Enrollment

Determining an Annual Premium for You and Your Spouse/Domestic Partner

General Information

Your Rights

General Information

General Information

Glossary of Key Terms

Prescription Drug Program Design

A Summary Chart of Your Prescription Drug Coverage

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

Prior Authorization

How to Fill Your Prescriptions at a Retail Pharmacy

How to Fill Your Prescriptions through the Mail Service Pharmacy

General Information

Notification

Election Procedure

Payment

When Continuation Coverage Ends

Trade Act Implications

General Information

How Coordination of Benefits Works

Medicare

General Information

Retiree Group Health Program Claims

General Information

Procedure for Filing a Claim

General Information

Right of Recovery

Right to Reimbursement, Assignment of Rights, and Duty to Notify

General Information

Who Is Eligible – Closed Eligibility Group

General Information

Receive Information About Your Program and Benefits

Continue Group Health Plan Coverage

Prudent Actions by Plan Fiduciaries

Enforce Your Rights

Assistance With Your Questions

To be treated in a manner that respects your privacy and dignity as a person.

To receive assistance in a prompt, courteous, and responsive manner.

To be provided with information about your benefits, any exclusions and limitations associated with the Program, and any charges for which you will be responsible.

To be provided with guidance and recommendations for continuation of coverage.

To the confidential handling of all communications and medical information maintained by the claims administrator, as provided by law and professional ethics.

To be informed by your treating provider of your diagnosis, prognosis, and plan of treatment in terms you understand. You are encouraged to ask questions of your provider until you fully understand the care you are receiving.

To receive prompt, courteous, and appropriate treatment.

To be informed by your treating provider about any treatment you may receive. Your provider will request your consent for all treatment, unless there is an emergency and your life and health are in serious danger. If written consent is required for special procedures, such as surgery, be sure you understand the procedure and why it is advised.

To refuse treatment and be advised of the probable consequences of your decision by your treating provider. You are encouraged to discuss your objections with your provider. He or she will advise you and discuss alternative treatment plans with you, but the final decision as to how to proceed is yours.

To be provided automatically, without charge, a list of participating providers and participating pharmacies in your area.

To change your provider through your coverage option under the Medical Program as applicable.

To express a complaint to the claims administrator about the care you have received or will not receive, and to receive a response in a timely manner.

To initiate the grievance procedure if you are not satisfied with the decision regarding your complaint about care.

To file a claim (pre-service or post-service) for a benefit with the claims administrator and to have any denial of a claim for benefit reviewed by the claims administrator under ERISA’s claim procedure rules. See the “ERISA Claims and Appeals Procedures” section for details.