| Navigation Options | |
 |
|
| Table of Contents | |
|
|
|
Detailed Table of Contents |
|
|
| Index | |
|
|
Introduction
Who Is Eligible
 |
|
 |
|
|
|
|
Enrolling for Coverage
|
|
|
Program Premium Cost
|
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
|
Your ERISA Rights
|
|
|
|
|
|
Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - RR Donnelley
How the Retiree Group Health Program Works
What Is an Expense That May Be a Covered Expense – Mental Health and Substance Abuse Program
Expenses under the Mental Health and Substance Abuse Program that may qualify as covered expenses are described on the following pages, provided they are not excluded as an expense that is not covered.
 | Hospital charges for room and board in a semiprivate room. |
| Licensed ambulance services to or from the nearest hospital that can provide the necessary mental health or substance abuse treatment. |
| Licensed inpatient or outpatient hospital services to treat mental health or substance abuse. |
| Licensed outpatient facility charges to treat mental health and/or substance abuse. |
| Professional services to treat a mental health and/or substance abuse condition. |
Services must be provided by an appropriately licensed or certified mental health and/or substance abuse provider (or other) other than a relative.
