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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 Prescription Drug Program Works
Prescription Drug Program Design
Your coverage under the Prescription Drug Program pays benefits using three different cost-sharing levels, or “tiers.” Each tier then refers to a drug’s classification on the Primary/Preferred Drug List. As a result, the amount you pay depends on all of the following:
 | Which tier of drug classification you select on the Primary/Preferred Drug List, including: |
 | Generic; |
| Brand-name preferred drug (on the claims administrator’s approved list, except as noted in the “What Expense Is Excluded From Being a Covered Expense – Prescription Drug Program” section); or |
| Brand-name non-preferred drug (not on the claims administrator’s approved list, and as noted in the “What Expense Is Excluded From Being a Covered Expense – Prescription Drug Program” section). |
| Whether you or your spouse/domestic partner obtains your prescription drug service from a participating or non-participating retail pharmacy. |
| Whether you or your spouse/domestic partner receives your prescription through the mail service. |
