Important Benefit Information

You should keep these points in mind when using the benefits provided by the Plan:

• Pre-approval is required for elective or non-emergency hospitalization or elective Inpatient surgery. You must call the Blue Cross Blue Shield Medical Service Advisory (MSA) at least one business day before you go into the Hospital, or within two business days of the date of an emergency admission.You must pay an additional $250 copayment if you do not call the MSA. See the back of your medical ID card for instructions. You are encouraged, but not required, to contact the MSA for maternity admissions.
  
• If you and your spouse become divorced or legally separated, you or your spouse must notify the Fund Office. Your spouse is not eligible for coverage under the Plan as your Dependent as of the date of your divorce or legal separation. Your spouse may be eligible for continuing coverage for 36 months after the divorce or legal separation under COBRA, however. To be eligible for that COBRA coverage, you or your spouse must notify the Fund Office within 60 days of the divorce or legal separation. Please see page 21 or contact the Fund Office if you have any questions about continuing coverage under COBRA.
  
• If your Child loses Dependent status under the Plan because your Child no longer meets the Plan’s definition of Dependent, you, your spouse, or your Dependent Child must notify the Fund Office within 60 days of the loss of status in order to be eligible for COBRA Continuation Coverage. See page 21 or contact the Fund Office if you have any questions about continuing coverage under COBRA.
  
• Certain routine diagnostic tests are covered by the Wellness Benefit. Other tests may be covered if you receive pre-approval by the Fund Office. See page 37 for more details about the tests that are covered under the Wellness Benefit.
  
• This Plan coordinates its healthcare benefits (but not prescription drug benefits) with the benefits of any other Plan under which you and your Dependents are covered. If you and/or your Dependents are covered under another plan, you must report all other coverage directly to the Fund Office.
  
• Call the Fund Office at 1-708-449-7373 or Blue Cross Blue Shield at 1-800-810-BLUE or visit the Blue Cross Blue Shield of Illinois website at www.bcbsil.com to find out if a particular provider is a Plan/PPO contracted provider – before you use their services.
  
• The fact that your Physician may prescribe, order, recommend or approve a particular service or supply does not make it Medically Necessary or make the expense a covered charge under the Plan. See page 29 for more detailed information about covered medical expenses.