| Navigation Options | |
 |
|
| Table of Contents | |
|
|
|
Detailed Table of Contents |
|
|
| Index | |
|
|
Introduction
Who Is Eligible
 |
|
 |
|
|
|
|
|
Enrolling for Coverage
|
|
|
Program Premium Cost
| Determining an Annual Premium for You and Your Spouse/Domestic Partner |
|
|
|
|
Your Rights and Responsibilities
|
|
How the Retiree Group Health Program Works
|
|
|
|
|
|
|
|
|
|
|
| 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 |
|
|
|
|
|
|
|
|
|
|
| What Is an Expense That May Be a Covered Expense – Medical Program |
|
|
|
|
|
| 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
|
|
|
|
| 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 |
|
|
| How to Fill Your Prescriptions through the Mail Service Pharmacy |
Your Legal Right to Continuation Coverage
|
|
|
|
|
|
Coordinating Benefits With Other Programs
|
|
|
How to File a Claim
|
|
ERISA Claims and Appeals Procedures
|
|
Situations Affecting Your Benefits
|
|
| Right to Reimbursement, Assignment of Rights, and Duty to Notify |
Administrative and Contact Information
|
Special Rules for Certain Participants
|
|
|
|
|
|
|
| Wallace, Litho, Nielsen Retiree Group (retired on or after January 1, 2004) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Skilled Nursing Facility/Inpatient Rehabilitation Facility Services |
| Spinal Treatment, Chiropractic, and Osteopathic Manipulative Therapy |
|
|
|
|
|
|
|
|
| Experimental or Investigational Services or Unproven Services |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Your ERISA Rights
|
|
|
|
|
|
Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - Moore Wallace
ERISA Claims and Appeals Procedures
Initial Benefit Determination
Claim Involving Urgent Care
In the case of a claim that involves urgent care, the claims administrator will notify the claimant of the benefit determination (whether adverse or not) no later than 72 hours after receipt of the claim by the claims administrator. The claimant must, however, provide sufficient information to determine whether, and to what extent, benefits are payable under the Plan.
If the claimant fails to provide sufficient information to determine whether, and to what extent, a claim involving urgent care is covered by the Plan, the claims administrator will notify the claimant within 24 hours after receipt of the claim of the specific information necessary to complete the claim.
The claimant will be given a reasonable amount of time, taking into account the circumstances, but in no event less than 48 hours, to provide the specified information. The claims administrator will notify the claimant of the benefit determination no later than 48 hours following the earlier of:
 | The claims administrator’s receipt of the specified information; or |
| The end of the period afforded to the claimant to provide the specified additional information. |
