• 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