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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
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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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Your ERISA Rights
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Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - RR Donnelley
How the Retiree Group Health Program Works
General Information
Out-of-Pocket Limits
The annual out-of-pocket limit is the most you and your spouse have to pay in coinsurance for covered expenses for you and your spouse in any calendar year. Once you and your spouse reach the out-of-pocket limit, the Retiree Group Health Program pays 100% of your additional covered expenses for the remainder of that calendar year.
Certain charges do not apply toward the out-of-pocket limit. These include:
 | Any amount you and your spouse pay above the maximum reimbursable charge when seeking care outside the CIGNA network; |
| Any additional penalty amount you and your spouse may be required to pay for not precertifying a hospital admission or stay (where applicable); and |
| Any expense that is not considered a covered expense, is above the contract amount, or exceeds other Retiree Group Health Program limits. |
