Welfare Summary Plan Description - Plan C Bargained & Non-Bargained

Table of Contents :

• Important Contact Information
• Important Benefit Information
• Schedule of Benefits 

Eligibility for Benefits - Bargained Members

• Your Initial Eligibility if You are a Bargained Member
• Your Dependents' Eligibility
• Qualified Medical Child Support Order (QMCSO)
• Continuation of Eligibility if You are a Bargained Member
• Termination of Eligibility if You are a Bargained Member
• Termination of Dependent Eligibility for Bargained Members
• Reinstatement of Eligibility 
• Enrollment Procedures
• Special Enrollment

Eligibility for Benefits - NON-BARGAINED Members

• Initial Eligibility for Non-Bargained Members
• Your Dependents' Eligibility
• Continuation of Eligibility - Non-Bargained Members
• Termination of Eligibility - Non-Bargained Member
• Termination of Dependent Eligibility for Non-Bargained Members
• Reinstatement of Eligibility - Non-Bargained Member
• Enrollment Procedures
• Special Enrollment
• Employee Contributions - Non-Bargained Employees

Life Events

• Getting Married
• Adding a Child
• Getting Divorced or Legally Separated
• Child Losing Eligibility
• Taking A Family and Medical Leave of Absence
• Taking a Military Leave
• In the Event of Death
• When You Stop Working or Retire

Continuation of Health Benefits

• Continuation of Coverage During Family and Medical Leave
• Continuation of Coverage During Military Leave
• COBRA Continuation Coverage

Comprehensive Major Medical Benefit
(Employees and Dependents)

• Preferred Provider Organization (PPO)
• Calendar Year Deductible
• Common Accident
• Coinsurance
• Out-of-Pocket Maximum
• Pre-Admission Authorization
• Covered Expenses
• Hospice Benefit
• Extension of Benefits

Wellness Expense Benefit

Substance Abuse Employee Assistance Program (EAP) (Employee and Dependents)

Optical Benefits (Employees and Dependents)

• Opt-Out of Optical Benefits

Hearing Aid Benefit (Employees and Dependents)

Prescription Drug Benefits (Employees and Dependents)

• Retail Pharmacy Network
• Affordable Care Act Preventative Items and Services
• Mail Order Prescription Drug Service
• Prescription Drug Exclusions and Limitations
• Prescription Drug Benefits Coordination with Medicare Part D

Death Benefit (Active Employees Only)

Accidental Death and Dismemberment Benefits (Active Employees Only)

Weekly Accident and Sickness Disability Benefit

General Exclusions and Limitations

How to File a Claim

• Filing Claims Other than Major Medical Claims
• Workers' Compensation Claims Procedures
• Claim Filing Period
• Assignment of Benefits
• Comprehensive Major Medical Benefit Claims
• Weekly Accident and Sickness Disability Benefit Claims
• If your Claim is Denied
• Appealing the Denial of Your Claim
• Limitation on Legal Actions
• Payment of Benefits
• Wrongful or Erroneous Benefit Payments

Coordination of Benefits

• Determining Which Plan Pays First
• Information Required for Coordination of Benefits

How Medicare Affects Medical Benefits Under the Plan

• About Medicare
• Coordination of Your Plan Benefits with Medicare

Reimbursement Policies and Procedures

• Benefits to Which Reimbursement Applies
• Situations Where Reimbursement Provisions May Apply
• Reimbursement Procedures
• Refusal to Cooperate in Reimbursement Claims

Important Information About the Plan

Statement of Rights Under the Employee Retirement Income Security Act (ERISA)

Your Privacy Rights Under the Plan

Definitions

Appendix A: Durable Medical Equipment and Supplies