2013 USX Office SPD.pdf - US Xpress

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