| |
|
Basic Plan SPD
>> Table of Contents
-
Important Notice
- Eligibility and Participation
- When You Are Eligible
- When You Are No Longer Eligible
- If You Come Back to Work
- Extension of Health Benefits
- COBRA
- FMLA
- Military Leave
- Dependent Eligibility
- When Your Dependents Are No Longer Eligible
- How to Enroll
- Your Notification Responsibility
- What Benefits Are Provided
- Hospital and Medical Benefits
- Overview of Eligible Expenses
- About the MagnaCare Networks
- In-Network Benefits
- When You Go Out-of-Network
- Coverage When You Are Away from Home
- Benefit Maximums
- Conditions for Hospital and Medical Expense Reimbursement
- Pre-Certification
- Pre-Certification for Medical/Hospital
- Covered Services
- In the Hospital and Outpatient Treatment Centers
- Skilled Nursing Care Facility
- Hospice Care Facility
- Home Health Care
- Emergency Care
- Care in the Doctor’s Office
- Preventive Medical Care
- Pregnancy and Maternity Care
- Physical, Occupational, Speech or Vision Therapy
(including rehabilitation
- Durable Medical Equipment and Supplies
- Excluded Hospital And Medical Expenses
- Prescription Drug Benefits
- At the Pharmacy
- Through Mail Order
- Eligible Drugs
- Excluded Drugs
- Dental Benefits
- How the Plan Works
- The 32BJ Dental Center
- Participating Dental Providers
- What Dental Services Are Covered
- Frequency Limitations
- Schedule of Covered Dental Services at the 32BJ Dental Center
- Alternate Benefit
- Access to Discounted Services from Network Dentists
- What Is Not Covered
- Vision Care Benefits
- Eligible Expenses
- Excluded Expenses
- Life Insurance Benefits
- Benefit Amount
- Naming a Beneficiary
- Life Insurance Disability Extension
- When Coverage Ends
- Accidental Death & Dismemberment (AD&D) Benefits
- How AD&D Benefits Work
- What Is Not Covered
- When Coverage Ends
- Death Benefit For Pensioners
- Claims and Appeals Procedures
- Claims Reviewers
- Appeals Reviewers
- Subrogation Vendor
- Glossary
- Footnotes
- Translation Notice
- Contact Information
Basic Plan SPD : Section II
>> Table of Contents
- Your Rights And Other Important Plan Information
- Plan Facts
- Funding of Benefits and Type of Administration
- Agent for Service of Legal Process
- Plan Sponsor and Administrator.
- Participating Employers
- Your Disclosures To The Fund
- Fraud
- Overpayments
- Claims and Appeals Procedures
- Claims for Benefits
- Filing Hospital and Medical Claims
- Filing Dental Claims
- Filing Pharmacy Claims
- Filing Employee Assistance Program (EAP) Claims
- Filing Vision Claims
- Filing Pensioner’s Death Benefit Claim
- Filing Life Insurance and AD&D Claims
- Where to Send Claim Forms
- Approval and Denial of Claims
- Health Service Claims (hospital/medical, EAP, pharmacy, dental and vision)
- Life and AD&D Claims
- Pensioner’s Death Benefit Claims
- Notice of Decision
- Appealing Denied Claims
- Filing an Appeal
- Where to File an Appeal
- Time Frames for Decisions on Appeals
- Expedited Appeals for Urgent Care Claims
- Pre-Service or Concurrent Medical, Hospital, Pharmacy, EAP or Dental Claim Appeal
- Post-Service Medical, Hospital, Pharmacy, EAP, Dental, or Life and AD&D Claim Appeal
- Voluntary Second Level Appeal of a Medical, Hospital, Pharmacy, EAP, Dental, or Life and AD&D Claim
- Vision, or Pensioner’s Death Benefit Claim Appeal
- Appeal Decision Notice
- Further Action
- Coordination Of Benefits
- Medicare
- TRI-CARE
- No-fault Benefits
- Other Coverage Provided By State or Federal Law
- Workers’ Compensation
- Subrogation And Reimbursement
- Continued Group Health Coverage
- During a Family and Medical Leave
- During Military Leave
- Under Cobra
- COBRA Continuation of Coverage
- Other Health Plan Information You Should Know
- Assignment of Plan Benefits
- No Liability for Practice of Medicine
- Privacy of Protected Health Information
- Certificate of Creditable Coverage
- Converting to Individual Coverage
- How Benefits May Be Reduced, Delayed or Lost
- Compliance with Federal Law
- Plan Amendment or Termination
- Statement of Rights under the Employee Retirement Income
Security Act of 1974 as Amended
|
|
|
