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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
Preadmission Certification - CIGNA
How to Precertify Your Hospital Admission
If you or your spouse/domestic partner is younger than age 65, you or your spouse/domestic partner must call the claims administrator to precertify a scheduled hospital admission at least 24 hours before you or your spouse/domestic partner is admitted. When you or your spouse/domestic partner calls, be prepared to provide information regarding your upcoming hospitalization, including the full name, address, and phone number of your provider.
The claims administrator’s toll-free phone number is listed on your ID card. Your regular physician or authorized specialist may work directly with the claims administrator to obtain approval for your admission. However, it is your responsibility to make sure your hospital stay is approved.
A health care professional reviews your request, and you or your spouse/domestic partner and your physician or your spouse/domestic partner’s physician is notified as soon as possible regarding the approved length of stay. If the request for hospitalization is not approved, the claims administrator discusses the case with the provider to reach an agreement regarding the appropriate treatment to follow.
