RR Donnelley
SPD Xpress
Advanced Search
Retiree Medical Prescription Drug, and Mental Health and Substance Abuse Programs Detailed Table of Contents
Navigation Options
Table of Contents
Detailed Table of Contents
Index

Introduction

Who Is Eligible

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

Enrolling for Coverage

General Information

Enrolling Yourself and Your Spouse

Eligible Surviving Spouse’s Enrollment

If You or Your Spouse Is Receiving Treatment When Coverage Begins

Program Premium Cost

Determining an Annual Premium for You and Your Spouse

Total Cost of Coverage

Annual Subsidy Cap Amount

Continuous Service

Examples

If You Are Involuntarily Separated

If You Are on an Authorized Leave of Absence

If You Die

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 and Responsibilities

General Information

Your Rights

Statement of Rights Under the Newborns’ and Mothers’ Health Protection Act

Your Responsibilities

How the Retiree Group Health Program Works

General Information

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

How the Prescription Drug Program Works

General Information

Glossary of Key Terms

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

Your Legal Right to Continuation Coverage

General Information

Notification

Election Procedure

Payment

When Continuation Coverage Ends

Trade Act Implications

Coordinating Benefits With Other Programs

General Information

How Coordination of Benefits Works

Medicare

Medicare Part A (Hospital Insurance) and Part B (Medical Insurance)

Examples

Medicare Part C

Medicare Part D

How to File a Claim

General Information

Retiree Group Health Program Claims

Medicare Electronic Claim Submission (Medicare Crossover)

Filling Prescriptions at Non-Participating Retail Pharmacies

ERISA Claims and Appeals Procedures

General Information

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

Situations Affecting Your Benefits

General Information

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

Administrative and Contact Information

General Information

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

Your ERISA Rights

General Information

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

Print AllPrevious PageNext Page

How the Prescription Drug Program Works

How to Fill Your Prescriptions Through the Mail Service Pharmacy

If you or your spouse needs to take a prescription drug for an extended period of time, you can purchase such prescriptions through the mail (maximum 90-day supply). Your medications are delivered to your home. Purchasing prescription drugs through the mail service pharmacy enables you to minimize your out-of-pocket costs for long-term maintenance prescriptions.

To fill your prescriptions through the mail service pharmacy:

Complete a confidential Mail Service Order Form when you or your spouse submits the first prescription by mail. It is important to complete the form for all individuals for whom you or your spouse is requesting a prescription. If you or your spouse changes or adds medications, or you or your spouse has a medical condition that you or your spouse did not previously report, you or your spouse must update your profile.

Ask your provider to write a prescription for a 90-day supply, plus the appropriate refills for up to a maximum of one year. (After the one-year period, a new prescription is required.) Submit the original prescriptions with the covered individual’s name and ID number clearly marked on the back. Also include the completed Mail Service Order Form (you may want to keep a copy for your records).

Submit your copayment (by either check or credit card number). If you pay by credit card, you or your spouse can order refills by phone or online (provided your original prescription is valid). After you or your spouse uses all of the refills noted on the original prescription, you or your spouse needs to submit a new prescription as outlined above.

Coverage under the Program ends when any of the following conditions occur:

A covered individual has received the maximum $2 million in benefits under the Retiree Group Health Program for all illnesses. If coverage for a retiree ends because the maximum $2 million in benefits has been paid, coverage for his or her spouse continues until termination of the spouse’s coverage because the spouse has received $2 million in benefits under the Retiree Group Health Program or for any of the other reasons listed below.

A covered individual dies. However, if a retiree has coverage under the Program and dies, the retiree’s spouse can continue his or her coverage under the Program, regardless of whether he or she remarries or becomes eligible under another employer’s plan.

You do not pay the required premiums for coverage. Payment is due on or before the effective date of coverage, which is the first of each month. If payment is not received within 30 days of the effective date of coverage, coverage for you and your spouse is terminated retroactively as of the date through which full payment was received. Coverage under the Program can be reelected only during Annual Enrollment.

In the event of a legal separation or divorce, coverage for a spouse is automatically terminated as of the date the legal separation or divorce occurs.

The Program or Plan (in whole or in part) can be discontinued for any reason.

If you are reemployed by RR Donnelley in a benefits-eligible position 30 or more days after your termination date, and you have already enrolled in this Program, your coverage under the Program will be suspended. As an active employee, you must select from the available options offered under the Active Program if you want coverage. Because you cannot be simultaneously covered under both the Active Program and this Program, you will not be able to remain covered under this Program. When you next terminate employment, you will again be eligible for coverage under this Program.

In some cases, you or your spouse may continue coverage under COBRA if his or her coverage under this Program ends.

Previous PageNext Page

 

 


Copyright © 1998-2002 RR Donnelley.