Retiree Eligibility Requirements
Benefits-Eligible Position
Examples
If You Are Involuntarily Separated
If You Are on an Authorized Leave of Absence
If You Die
Spouse Eligibility Requirements
General Information
Enrolling Yourself and Your Spouse
Eligible Surviving Spouse’s Enrollment
If You or Your Spouse Is Receiving Treatment When Coverage Begins
Determining an Annual Premium for You and Your Spouse
Total Cost of Coverage
Annual Subsidy Cap Amount
Continuous Service
If You Are Not Eligible for an Annual Subsidy Cap Amount
How Your Monthly Contributions Change When You or Your Spouse Becomes Eligible for Medicare
Making Required Premium Payments
Your Rights
Statement of Rights Under the Newborns’ and Mothers’ Health Protection Act
Your Responsibilities
Deductibles
Coinsurance
Out-of-Pocket Limits
Lifetime Maximum Benefit
Glossary of Key Terms
Retiree Group Health Program Design – Medical Programs
Primary Care Physicians (PCPs)
Specialty Care
Emergency Care
Urgent Care
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
Retiree Group Health Program – Other Services Available
Disease Management Services
CIGNA HealthCare Healthy Rewards
CIGNA HealthCare Health Information Line
CIGNA HealthCare Health Information Library
CIGNA HealthCare Medical Self-Service
Preadmission Certification – CIGNA
How to Precertify Your Hospital Admission
If You Do Not Precertify a Hospital Admission
Emergency Notification
What Is an Expense That May Be a Covered Expense – Medical Program
Professional Services
Reproductive Services
Outpatient Hospital/Facility and Emergency Room Services
Inpatient Hospital Services
Miscellaneous Services
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
Prescription Drug Program Design
A Summary Chart of Your Prescription Drug Coverage
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
Prior Authorization
How to Fill Your Prescriptions at a Retail Pharmacy
How to Fill Your Prescriptions Through the Mail Service Pharmacy
Notification
Election Procedure
Payment
When Continuation Coverage Ends
Trade Act Implications
How Coordination of Benefits Works
Medicare
Medicare Part A (Hospital Insurance) and Part B (Medical Insurance)
Medicare Part C
Medicare Part D
Retiree Group Health Program Claims
Medicare Electronic Claim Submission (Medicare Crossover)
Filling Prescriptions at Non-Participating Retail Pharmacies
Procedure for Filing a Claim
Defective Claims
Initial Claim Review
Initial Benefit Determination
Claim Involving Urgent Care
Concurrent Care Decision
Pre-Service Claim
Post-Service Claim
Manner and Content of Notification of Denied Claim
Review of Initial Benefit Denial
Procedure for Filing an Appeal of a Denial
Review Procedures for Denials
Timing of Notification of Benefit Determination on Review
Manner and Content of Notification of Benefit Determination on Review
Legal Action
Right of Recovery
Right to Reimbursement, Assignment of Rights, and Duty to Notify
Right to Reimbursement
Assignment of Rights
Duty to Notify
If the Plan Is Modified or Ended
Type of Plan
Plan Sponsor
Employer Identification Number of Plan Sponsor
Plan Name and Number
Plan Year End
Agent for Service of Legal Process
Benefits Committee and Plan Administrator
Eligibility Administration
Claims Administrator and Network Manager
Claims Administrator for Eligibility Claims
COBRA Administrator for Continuation Coverage
Allocation and Delegation of Fiduciary Responsibilities by the Benefits Committee
Trust and Insurance
Self-Funded Benefits
Insured Benefits
Participating Employers
Special Rules for Certain Participants
Receive Information About Your Program and Benefits
Continue Group Health Plan Coverage
Prudent Actions by Plan Fiduciaries
Enforce Your Rights
Assistance With Your Questions
Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - RR Donnelley
2007 Summary Chart
2006 Summary Chart
Copyright © 1998-2002 RR Donnelley.