2013 Employee Benefits Guidebook - Administration Home
2013 Employee Benefits Guidebook - Administration Home
2013 Employee Benefits Guidebook - Administration Home
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Pregnancy *<br />
Initial visit<br />
(to confirm Pregnancy)<br />
100% after $75 Specialist office<br />
visit copayment<br />
Not Covered<br />
All subsequent prenatal visits, postnatal<br />
visits, and Physician’s delivery charges (i.e.,<br />
global maternity fee)<br />
Physician’s office visits in addition to the<br />
global maternity fee (when performed by an<br />
OB/GYN or specialist)<br />
75% after deductible<br />
100% after $75 office visit<br />
copayment<br />
No deductible applies<br />
Not Covered<br />
Not Covered<br />
Delivery – Facility charges<br />
(Inpatient Hospital, Birthing Center)<br />
Payable per Inpatient<br />
Hospitalization benefit<br />
Not Covered<br />
* Note: If a Clinic referral is received either to confirm a Pregnancy or after the initial diagnosis has been<br />
made and the Covered Person also enrolls in the CareLink Priority Maternity Care program during the<br />
first trimester of the Pregnancy, the Covered Person will not be subject to the inpatient hospital copay,<br />
inpatient hospital deductible or inpatient Physician deductible for the delivery charges or other pregnancy<br />
related treatment (billed with a primary diagnosis of “Pregnancy”). ER copay will also be waived if the vi<br />
is Pregnancy related (billed with a primary diagnosis of “Pregnancy”)<br />
Organ Transplants<br />
Payable as any other Illness<br />
Not Covered<br />
Transportation Benefit Maximum<br />
(Available only when using a COE facility)<br />
$10,000 Lifetime Maximum<br />
Note: See the Covered Charges section for more information regarding this benefit.<br />
Wigs<br />
75% after deductible<br />
$1,000 Lifetime Maximum<br />
Note: Limited to the initial purchase of a wig when deemed Medically Necesssary due to temporary or permanen<br />
hair loss. See the Covered Charges section for more information regarding this benefit.<br />
All Other Eligible Charges 75% after deductible Not Covered<br />
This <strong>Guidebook</strong> is only a summary of benefits and is not a binding contract. Summary Plan Documents, Certificates of<br />
Coverage, and the El Paso County Policies and Procedures Manual describes benefits in great detail and are available<br />
through ESS or by contacting the <strong>Employee</strong> <strong>Benefits</strong> office. Should there be differences between this summary and the plan<br />
documents, contracts or policies, the plan documents, contract, and/or policies will govern.<br />
<strong>2013</strong> <strong>Employee</strong> Benefit <strong>Guidebook</strong><br />
Updated August <strong>2013</strong>