Huntington Ingalls Newport News Anthem Key ... - Benefits Connect

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Helpful tip: Look for these icons to identify which services are considered inpatient and which are outpatient. Inpatient Outpatient Individual Family Key words There are a few key words you will see repeated throughout this booklet. We’ve highlighted them here to make the booklet easier to understand. In addition, we have included a Definitions section on page 77 that lists the various words referenced. A defined word will be italicized each time it is used. We, us, our, Anthem Anthem Blue Cross and Blue Shield. Covered persons You and enrolled eligible dependents. Outpatient When you receive care in a hospital outpatient department, emergency room, professional provider’s office, or your home. Inpatient When you are a bed patient in the hospital. You The enrolled employee. Your health plan Your employer’s health care plan through which benefits described in this booklet are available. Copayment The fixed dollar amount you pay for some covered services. Coinsurance The percentage of the maximum allowed amount you pay for some covered services. Deductible The fixed dollar amount of covered services you pay in a calendar year before your health plan will pay for any remaining covered services during that calendar year.
Table of contents page Summary of benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 How your health plan works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Covered providers and facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Hospital Admission Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 If you have a pre-existing condition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 What is covered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 What is not covered (Exclusions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Claims and payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 What you will pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 When you must file a claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 When you are covered by more than one health plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Coordination of benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Eligibility for coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Eligible dependents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 After you become eligible for Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Continuation of coverage (COBRA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Important information about your health plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Complaint and appeal process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Member’s rights and responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Exhibit A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Experimental/investigative criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Clinical trial costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Page 1 and 2: Huntington Ingalls Industries, Inc.
Page 3 and 4: SUMMARY PLAN DESCRIPTION KEYCARE 15
Page 5 and 6: SECTION I - MEMBER CERTIFICATE This
Page 7: STEELWORKERS HEALTH AND WELFARE FUN
Page 12 and 13: Index. . . . . . . . . . . . . . .
Page 14 and 15: 2 - Summary of benefits In-network
Page 16 and 17: 4 - Summary of benefits In-network
Page 18 and 19: 6 How your health plan works Your h
Page 20 and 21: 8 - How your health plan works Choo
Page 22 and 23: 10 - How your health plan works All
Page 24 and 25: 12 - How your health plan works Bef
Page 26 and 27: 14 - How your health plan works •
Page 28 and 29: 16 What is covered Your health plan
Page 30 and 31: 18 - What is covered • nuclear ca
Page 32 and 33: 20 - What is covered • services o
Page 34 and 35: 22 - What is covered If your doctor
Page 36 and 37: 24 - What is covered How your healt
Page 38 and 39: 26 - What is covered We have establ
Page 40 and 41: 28 - What is covered Services of no
Page 42 and 43: 30 - What is covered Morbid obesity
Page 44 and 45: 32 - What is covered Physical thera
Page 46 and 47: 34 - What is covered Your health pl
Page 48 and 49: 36 - What is not covered This exclu
Page 50 and 51: 38 - What is not covered However, i
Page 52 and 53: 40 - What is not covered Your cover
Page 54 and 55: 42 - What is not covered W Your cov
Page 56 and 57: 44 - Claims and payments Out-of-net
Page 58 and 59: 46 - Claims and payments Providers
Page 60 and 61:
48 - Claims and payments • the ou
Page 62 and 63:
50 - Claims and payments In additio
Page 64 and 65:
52 When you are covered by more tha
Page 66 and 67:
54 - When you are covered by more t
Page 68 and 69:
56 - Eligibility for coverage Chang
Page 70 and 71:
58 - Eligibility for coverage will
Page 72 and 73:
60 - Eligibility for coverage Depen
Page 74 and 75:
62 - Eligibility for coverage Conti
Page 76 and 77:
64 - Eligibility for coverage When
Page 78 and 79:
66 - Eligibility for coverage A qua
Page 80 and 81:
68 - Important information about yo
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
76 - Member’s rights and responsi
Page 90 and 91:
78 - Definitions Emergency services
Page 92 and 93:
80 - Definitions Out-of-network is
Page 94 and 95:
82 - Definitions Skilled nursing fa
Page 96 and 97:
84 - Exhibit A Clinical trial costs
Page 98 and 99:
86 page Newborn . . . . . . . . . .
Page 100 and 101:
88 - Special features and programs
Page 102:
Anthem Blue Cross and Blue Shield 2
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Huntington Ingalls Newport News Anthem Key ... - Benefits Connect

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