CIGNA High Deductible Health Plan (HDHP) - UCAR Finance ...

Table of Contents
Important Information..................................................................................................................5
Special Plan Provisions..................................................................................................................7
Important Notices ..........................................................................................................................8
How To File Your Claim ...............................................................................................................8
Eligibility - Effective Date .............................................................................................................8
Employee Insurance ...............................................................................................................................................8
Waiting Period........................................................................................................................................................9
Dependent Insurance ..............................................................................................................................................9
Important Information About Your Medical Plan.....................................................................9
Open Access Plus Medical Benefits............................................................................................11
The Schedule ........................................................................................................................................................11
Certification Requirements - Out-of-Network......................................................................................................21
Prior Authorization/Pre-Authorized .....................................................................................................................21
Covered Expenses ................................................................................................................................................22
Prescription Drug Benefits..........................................................................................................29
The Schedule ........................................................................................................................................................29
Covered Expenses ................................................................................................................................................30
Limitations............................................................................................................................................................30
Your Payments .....................................................................................................................................................30
Exclusions ............................................................................................................................................................31
Reimbursement/Filing a Claim.............................................................................................................................31
Exclusions, Expenses Not Covered and General Limitations..................................................31
Coordination of Benefits..............................................................................................................34
Expenses For Which A Third Party May Be Responsible .......................................................36
Payment of Benefits .....................................................................................................................37
Termination of Insurance............................................................................................................38
Employees ............................................................................................................................................................38
Dependents ...........................................................................................................................................................38
Rescissions ...........................................................................................................................................................38
Federal Requirements .................................................................................................................38
Notice of Provider Directory/Networks................................................................................................................38
Qualified Medical Child Support Order (QMCSO) .............................................................................................39
Special Enrollment Rights Under the Health Insurance Portability & Accountability Act (HIPAA) ..................39
Coverage of Students on Medically Necessary Leave of Absence.......................................................................40
Effect of Section 125 Tax Regulations on This Plan............................................................................................41
Eligibility for Coverage for Adopted Children.....................................................................................................41
Coverage for Maternity Hospital Stay..................................................................................................................42