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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
If You Do Not Precertify a Hospital Admission
If you or your spouse/domestic partner is younger than age 65 and you or your spouse/domestic partner fails to precertify a hospital admission, the Program reduces benefits by $500. This means that you are responsible for paying $500 more than you would have paid if you or your spouse/domestic partner had precertified the admission (this does not apply to emergency admissions). The $500 precertification penalty is not a covered expense. Therefore, it does not apply to your annual deductible requirement or your out-of-pocket limit. In addition, any other covered expense for a hospitalization, surgery, or an unauthorized day may be denied. This means that your share of out-of-pocket costs could be significantly higher.
