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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
How the Retiree Group Health Program Works
Retiree Group Health Program Design – Mental Health and Substance Abuse Program
If you enroll yourself and your spouse/domestic partner in one of the Medical Programs, you and your spouse/domestic partner automatically are enrolled in the Mental Health and Substance Abuse Program.
CIGNA Behavioral Health (CBH) is the network manager for mental health and substance abuse care. CBH is the claims administrator. Mental health and substance abuse claims count toward your annual plan deductible (if applicable given your coverage option) and out-of-pocket limit.
Before you or your spouse/domestic partner receives care for mental health or substance abuse, you or your spouse/domestic partner needs to call the claims administrator at the number listed on your medical ID card to have the care approved. By calling ahead, you or your spouse/domestic partner will ensure that you or your spouse/domestic partner receives the highest available benefits to cover the cost of the care. If you or your spouse/domestic partner does not call and seeks care management and approval, the Mental Health and Substance Abuse Program may not pay benefits or it may pay benefits at the out-of-network level (given your coverage option). See the Summary Chart for your coverage option for details.
You or your spouse/domestic partner must precertify all inpatient services through CBH. Failure to obtain precertification results in a 50% reduction in benefits. Outpatient services do not require precertification. For an emergency admission, you or your spouse/domestic partner must notify CBH by the next business day.
