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

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6 How your health plan works Your health plan provides a wide range of health care services within a special network of health care providers and facilities. You will receive benefits based on where you receive health care services and the limits stated in the Summary of benefits (see page 1) and related exclusions. Your health plan is a self-funded employee welfare benefit plan sponsored by your employer. The cost of your coverage, which includes the plan benefits and administrative expenses, is borne by your employer. Employees may contribute to the cost through payroll deduction. Your employer has entered into an administrative services contract with <strong>Anthem</strong> to carry out certain functions with respect to claims operation. Carry your ID card Your <strong>Anthem</strong> Blue Cross and Blue Shield ID card identifies you as a covered person and contains important health care coverage information. When you show your ID card to your doctor, hospital, pharmacist, or other health care provider, they will file your claims for you in most cases. Carrying your card at all times will ensure you always have this coverage information with you when you need it. Covered providers and facilities Your health plan covers certain care administered by providers and facilities. To ensure benefits, providers and facilities must be licensed in the state where they operate to perform the service you receive and the service must be covered by your health plan. Certain services are covered by the plan and rendered by other covered medical suppliers, such as suppliers of medical equipment (durable), private duty nursing services, prescription drugs, ambulance services, etc. A provider may delegate to his employee the responsibility for performing a covered service. Your health plan will cover this care if we determine that a bona fide employer-employee relationship exists, based on information given by the provider. Under these circumstances: • both the provider and the delegated employee must be licensed/certified to render the service; • the service must be performed under the direct supervision of the provider since the provider is primarily responsible for the patient’s care; and • the provider who is directly supervising the service must bill for the service. Because the service of the delegated employee is a substitute for the provider’s service, your health plan will not pay a supervisory or other fee for the same service performed by both the provider and his delegated employee. P-WORKS (7/11)
How your health plan works - 7 Primary care physicians and specialty care providers Your health plan covers care provided by primary care physicians and specialty care providers. To see a primary care physician, simply visit any network physician who is a general or family practitioner, internist or pediatrician. Your health plan also covers care provided by any specialty care provider you choose. Referrals are never needed to visit any specialty care provider.
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 10 and 11: Helpful tip: Look for these icons t
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 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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