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

Your Legal Right to Continuation Coverage

General Information

A federal law called the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA), requires that most employers, including a Participating Employer (other than an outside member of the board of directors who has elected to participate), that sponsor medical benefit plans (including HMOs) offer employees and certain members of their families the opportunity to extend coverage temporarily at group rates after coverage under the medical benefits plan would otherwise end due to specific events. The extension of coverage to employees and their eligible spouses is called “continuation coverage.”

In general, the coverage that may be continued is the same as the coverage in which you and your spouse were enrolled under the Program on the day before the qualifying event (as listed below). For example, if you are enrolled in the Program with retiree and spouse coverage, you and your spouse can continue this same coverage under COBRA. In addition, if you elected the “No Coverage” option as a retired employee, you would not be eligible for any continuation coverage.

To be eligible for continuation coverage, a qualifying event must take place. After the qualifying event, continuation coverage must be offered to each person who is a continuation coverage beneficiary. You and your spouse could become continuation coverage beneficiaries if coverage under the Program is lost because of a qualifying event. The following are qualifying events:

Who Can Continue Coverage

In What Situations

For How Long

Retiree and spouse

Loss of coverage or increases in cost due to, or significant reduction in coverage within one year before or after, the commencement of bankruptcy proceedings under Title 11 of the United States Code with respect to RR Donnelley or its subsidiaries from whose employment you retired

Until death; however, in the case of the covered surviving spouse, no later than 36 months after the death of the covered former employee

Retiree’s spouse

Divorce or legal separation

36 months

If you or your spouse becomes eligible to participate in Medicare but does not elect to participate therein, you or your spouse may become entitled to certain COBRA rights. You should contact the COBRA administrator within 60 days of not electing Medicare to receive more information.

Previous PageNext Page

 

 


Copyright © 1998-2002 RR Donnelley.