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Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - Moore Wallace   
How the Retiree Group Health Program Works
What Is an Expense That May Be a Covered Expense – Medical Program
Inpatient Hospital Services
Inpatient hospital facility services – covered charges include:
 | Hospital room and board for a semiprivate room, isolation unit, or coronary care unit. Private room charges are covered when medically necessary as determined by the claims administrator.
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| Hospital services and supplies, including the use of an operating and recovery room, surgical dressings, X-ray exams, lab tests, drugs and medicines consumed during a hospital confinement, anesthetics and their administration, oxygen and its administration, and blood and blood plasma in excess of credits for blood replaced by individual blood donors. Private-duty nursing services inside the hospital are covered only as approved by the claims administrator. |
Inpatient surgery – includes all medically necessary, non-experimental surgery and supplies.
Organ transplants – all medically necessary, non-experimental transplants, including cadaver or live donor match testing, and inpatient facility and physician services. The Medical Program also pays benefits for immunosuppressive medication. Certain transplants are not covered based on the Office of Medical Applications of Research of the National Institute of Health’s ruling. Contact the claims administrator before you incur any related costs.
The CIGNA LIFESOURCE Transplant Network® is an organization of participating hospitals that provide organ transplant services. When you or your covered spouse/domestic partner receives care through this network, you or your spouse/domestic partner may be eligible for certain travel benefits related to the organ transplant. These benefits include up to $10,000 per transplant per lifetime for food, lodging, and transportation for the patient and one companion. This amount is taxable to you under federal law.
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