| Policy Series - Table of Contents |
| Series A - GENERAL PLAN INFO |
 |
| Overview |
1 |
| Series B - SUMMARY OF BENEFITS |
|
| In-Network Benefits |
1 |
| Out-of-Network Benefits |
2 |
| Series C - HOSPITAL EXPENSE BENEFITS |
|
| Inpatient Services |
1 |
| Outpatient Services |
2 |
| Inpatient Services |
3 |
| Outpatient Services |
4 |
| Series D - MEDICAL EXPENSE BENEFITS |
|
| OPTIONS FOR COVERAGE |
1 |
| PREFERRED PROVIDER ORGANIZATION (PPO) |
2 |
| MEDICAL-SURGICAL-PPO SERVICES: IN-NETWORK BENEFITS |
3 |
| MEDICAL-SURGICAL-NON-PPO SERVICES: INDEMNITY OPTION |
4 |
| MANAGED PSYCHIATRIC & SUBSTANCE ABUSE BENEFITS |
5 |
| PHYSICAL MEDICINE MANAGED PPO BENEFIT |
6 |
| WELL CARE BENEFITS |
7 |
| Series E - PRESCRIPTION DRUG EXPENSE BENEFITS |
|
| IN-NETWORK |
1 |
| ELIGIBILITY |
10 |
| OPEN ENROLLMENT PERIOD |
11 |
| CONTINUATION OF COVERAGE (COBRA) |
12 |
| EXTENDED PLAN BENEFITS |
13 |
| MANAGED BENEFITS PROGRAM |
14 |
| PROGRAMS |
15 |
| MANAGED PSYCHIATRIC AND SUBSTANCE ABUSE BENEFIT PROGRAM |
16 |
| MANAGED PHYSICIAL MEDICINE SERVICES CARE |
17 |
| MANAGED DECISION APPEALS |
18 |
| EXTERNAL “MANAGED CARE” APPEALS |
19 |
| SCHEDULE OF BENEFITS |
2 |
| EMPLOYEE ASSISTANCE PROGRAM |
3 |
| DEFINITIONS A-C |
4 |
| DEFINITIONS D-F |
5 |
| DEFINITIONS G-I |
6 |
| DEFINITIONS M-P |
7 |
| DEFINITIONS S-Z |
8 |
| WELLNESS & WELLCARE BENEFITS |
9 |
| Series F - EMPLOYEE ASSISTANCE PROGRAM |
|
| EMPLOYEE ASSISTANCE PROGRAM |
1 |
| COORDINATION OF BENEFITS |
10 |
| COORDINATION OF BENEFITS PROVISION |
11 |
| HOW IT WORKS |
12 |
| HOW YOUR BENEFITS ARE PAID |
13 |
| WHEN THIS PLAN IS SECONDARY |
14 |
| PLAN’S RIGHT OF RECOVERY |
15 |
| EFFECTS OF MEDICARE |
16 |
| ASSIGNMENT OF BENEFITS |
17 |
| AMENDMENT OR TERMINATION OF THE PLAN |
18 |
| AUTHORITY AND DISCRETIONARY CONTROL OF THE PLAN |
19 |
| HOSPITAL EXPENSE BENEFITS |
2 |
| NAMED FIDUCIARY |
20 |
| FUNDING POLICY |
21 |
| GENERAL INFORMATION |
22 |
| PROCEDURE |
23 |
| TIME LIMIT FOR CERTAIN DEFENSES |
24 |
| CERTAIN RIGHTS |
25 |
| RIGHT OF REIMBURSEMENT |
26 |
| IF YOU NEED HOSPITAL CARE |
27 |
| WHEN TO FILE A CLAIM |
28 |
| HOW TO FILE A CLAIM FOR OTHER HEALTH SERVICES |
29 |
| OUTPATIENT HOSPITAL CHARGES |
3 |
| METHOD OF PAYMENT |
30 |
| OTHER GROUP COVERAGE |
31 |
| INCOMPLETE CLAIMS FORMS |
32 |
| LATE SUBMISSION OF A CLAIM |
33 |
| AMBULANCE CHARGES |
4 |
| HOME HEALTH CARE |
5 |
| HOSPICE CARE |
6 |
| MEDICAL EXPENSE BENEFITS |
7 |
| PRESCRIPTION DRUG MANAGED CARE PROGRAM |
8 |
| BENEFITS |
9 |
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