2013 XGS Office SPD.pdf - US Xpress
2013 XGS Office SPD.pdf - US Xpress
2013 XGS Office SPD.pdf - US Xpress
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(1) The Company no longer provides group health coverage to any of its employees<br />
(2) You do not pay the premium for your continuation coverage on time<br />
(3) You become covered under another group health plan after the date of your COBRA<br />
election, unless that plan contains any exclusions or limitations with respect to any preexisting<br />
conditions you or your covered dependents may have<br />
(4) You become entitled to Medicare after the date of your COBRA election<br />
(5) You extended coverage for up to 29 months due to your disability and there has been a<br />
final determination that you are no longer disabled.<br />
You do not have to show that you are insurable to choose continuation coverage.<br />
In order to protect your family's rights, you should keep the Plan Administrator informed<br />
of any changes in the addresses of family members. You should also keep a copy, for your<br />
records, of any notices you send to the Plan Administrator.<br />
Maternity and Newborn Coverage<br />
Your Plan provides maternity and newborn infant coverage. Federal law generally prohibits this<br />
Plan from restricting benefits for any hospital length of stay in connection with childbirth for the<br />
mother or newborn child to less than 48 hours following a normal vaginal delivery, or less than 96<br />
hours following a cesarean section. Federal law also generally prohibits the Plan from requiring<br />
that a Provider obtain authorization to prescribe a length of stay in excess of the above periods.<br />
Please refer to the Covered Services section of the BlueCross BlueShield of Tennessee<br />
Evidence of Coverage document for details.<br />
Qualified Medical Child Support Order<br />
In accordance with section 609(a) of ERISA, the Plan will provide health benefit coverage to a<br />
child of a participant in accordance with the terms of any medical child support order that the Plan<br />
Administrator determines to be a "qualified medical child support order." A qualified medical child<br />
support order is a judgment, decree or order issued by a court, which provides for child support or<br />
health benefit coverage relating to benefits under the Plan and which meets certain requirements<br />
regarding substance and form. Medical child support orders should be submitted to the Plan<br />
Administrator, who will promptly notify the involved individuals of its receipt of the order and of the<br />
Plan's procedure for determining whether the order is a qualified order. You may request a copy<br />
of the Plan's procedure for determining whether an order is a qualified medical child support order<br />
from the Human Resources Department.<br />
Certificate of Creditable Coverage<br />
A certificate of creditable coverage is a document that reports the period of time that you and/or a<br />
dependent have had medical benefits coverage under the Plan without a significant break in<br />
coverage. This information may be helpful if you or a dependent become covered under a group<br />
health plan other than the Plan and that other group health plan contains a preexisting condition<br />
limitation. Under Federal law, your coverage or your dependent’s coverage under this Plan may<br />
reduce or eliminate the application of the other plan’s preexisting condition limitation.<br />
A certificate of creditable coverage will be provided automatically when your coverage or your<br />
dependent’s coverage under the Plan terminates. You or your dependent also have the right to<br />
request a certificate of creditable coverage from the Plan at any time, as long as your request is<br />
made within 24 months after your coverage or your dependent’s coverage under the Plan<br />
terminates. Requests should be directed to the Human Resources Benefits Department at1-800-<br />
670-1915.<br />
Medicaid-Eligible Individuals<br />
In determining whether an individual is eligible for health benefit coverage and is making benefit<br />
payments, the Plan will not take into account the fact that an individual is eligible for or is covered<br />
by Medicaid.<br />
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