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

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ADDITIONAL INFORMATION If you have any questions or require additional information regarding your Health Plan, please contact any of the following sources: Section Topic Contact I Enrollment Huntington Ingalls Benefits Center at 1-877-216-3222 Premium Contribution Amounts Changes in Eligibility When Coverage Ends II How Your Plan Works Anthem Blue Cross and Blue Shield Benefit Coverage 2015 Staples Mill Road Claims and Payments Richmond, VA 25230 Network Providers (800) 893-9626 On-site Anthem Representative (757) 688-8323 III ERISA Information Steelworkers Health and Welfare Fund Five Gateway Center Pittsburgh, PA 15222 (888) 831-3863
SECTION I – MEMBER CERTIFICATE This Section contains your Member Certificate issued to you by Anthem Blue Cross and Blue Shield and contained within this booklet. It begins immediately following the ERISA section of the Summary Plan Description. SECTION II - ERISA INFORMATION The following information supplements the Statement of ERISA Rights contained in Section II of this booklet. Name of Plan The name of the Plan is Anthem KeyCare 150 Health Plan for Employees Covered By The Collective Bargaining Agreement Between Huntington Ingalls Industries, Inc. and United Steelworkers, On Behalf Of Local 8888. The Plan is commonly known as The Huntington Ingalls Industries, Inc. Anthem KeyCare PPO Plan. Name And Address Of Employer Huntington Ingalls Industries, Inc., 4101 Washington Avenue, Newport News, Virginia 23607. Plan Sponsor The plan sponsor is The Steelworkers Health and Welfare Fund. Identification Numbers This Plan is identified by the following numbers: Plan Number: 501 Plan Administrator Identification Number: 23-1317409 Term of Plan The term of this Plan is July 1, 2011 through June 30, 2013. Type Of Plan This Plan is an Employee Welfare Benefit Plan designed to help meet the cost of health care by providing benefits for hospital care, medical/surgical services and special types of care to employees covered by the Collective Bargaining Agreement, Effective July 26, 2004, between Huntington Ingalls Industries, Inc. and the United Steelworkers on behalf of Local 8888. Administration of the Plan The benefits of this Plan are administered by Anthem Blue Cross and Blue Shield (“Anthem”) pursuant to a group insurance policy issued by Anthem to the Board of Trustees of the Steelworkers Health and Welfare Fund. Plan Administrator The Plan Administrator is the Board of Trustees of the Steelworkers Health and Welfare Fund. The Plan Administrator’s address is: Five Gateway Center, 7 th Floor, Pittsburgh, PA 15222. The Plan Administrator’s telephone number is (888) 831-3863.
Page 1 and 2: Huntington Ingalls Industries, Inc.
Page 3: SUMMARY PLAN DESCRIPTION KEYCARE 15
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 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
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42 - What is not covered W Your cov
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44 - Claims and payments Out-of-net
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46 - Claims and payments Providers
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48 - Claims and payments • the ou
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50 - Claims and payments In additio
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52 When you are covered by more tha
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54 - When you are covered by more t
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56 - Eligibility for coverage Chang
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58 - Eligibility for coverage will
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60 - Eligibility for coverage Depen
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62 - Eligibility for coverage Conti
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64 - Eligibility for coverage When
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66 - Eligibility for coverage A qua
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68 - Important information about yo
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76 - Member’s rights and responsi
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78 - Definitions Emergency services
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80 - Definitions Out-of-network is
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82 - Definitions Skilled nursing fa
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84 - Exhibit A Clinical trial costs
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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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