| Important Telephone
Numbers |
|
1.1 |
| Introduction |
|
1.2 |
| Identification Card |
|
1.2 |
| Primary Care Provider |
|
1.3 |
| Changing Your Primary Care Provider |
|
1.3 |
| In-Plan Specialty Services |
|
1.4 |
| Specialist as Primary Care Physician |
|
1.4 |
| Second Opinions |
|
1.4 |
| In-Plan Referrals |
|
1.5 |
| Standing Referrals to an AHP Specialist |
|
1.5 |
| Referrals to an AHP Specialty Care
Center |
|
1.5 |
| Changing Your Specialist |
|
1.5 |
| Out-of-Network Specialist Care &
Specialty Centers |
|
1.6 |
| Transitional Care |
|
1.6 |
| Hospital Services |
|
1.7 |
| Urgent Care After Hours |
|
1.7 |
| Emergency Care |
|
1.8 |
| Routine Gynecological Care |
|
1.9 |
| Obstetrical/Maternity Care |
|
1.9 |
| Hospice |
|
1.9 |
| Behavioral Health Care Services |
|
1.10 |
| Vision Care |
|
1.10 |
| Prescription Drugs |
|
1.10 |
| Chiropractic Care |
|
1.10 |
| Experimental and/or Investigational
Treatment or Procedures |
|
1.11 |
| Informed Consent and Advance Directives |
|
1.11 |
| Using Out-of-Plan Benefits |
|
1.12 |
| Submitting Claims |
|
1.12 |
| Covered Services |
|
1.13 |
| In-Plan Copayments |
|
1.13 |
| Out-of-Plan |
|
1.13 |
| Out-of-Plan Coinsurance |
|
1.14 |
| Out-of-Plan Service Penalties |
|
1.14 |
| Out-of-Plan Benefit Maximum |
|
1.14 |
| Excluded Services |
|
1.14 |
| Pre-authorization |
|
1.15 |
| Utilization Review |
|
1.15 |
| Appeal Procedures |
|
1.16 |
| Member Rights & Responsibilities |
|
1.20 |
| Member Service Department |
|
1.21 |
| The Grievance Process |
|
1.21 |
| Membership Issues |
|
1.23 |
| Member Acknowledgements |
|
1.25 |
| |
|
|
| GROUP SUBSCRIBER
CERTIFICATE OF COVERAGE |
|
2.3 |
| Introduction |
|
2.7 |
| Definitions |
|
2.8 |
| Eligibility and Family Coverage |
|
2.11 |
| Pre-Existing Condition Limitation |
|
2.13 |
| In-Plan Benefits |
|
2.14 |
| Accessing Out-of-Plan Benefits |
|
2.26 |
| Restrictions, Exclusions and Limitations |
|
2.26 |
| Your Primary Care Provider |
|
2.30 |
| In-Plan Refferrals |
|
2.31 |
| Pre-Authorization |
|
2.32 |
| Utilization Review |
|
2.33 |
| Member Complaints and Grievances |
|
2.34 |
| Co-Payments, Co-Insurance and Deductibles |
|
2.35 |
| Claim Payments |
|
2.36 |
| Provider Payment Methodoligies |
|
2.37 |
| Coordination of Benefits |
|
2.38 |
| Termination of Coverage |
|
2.40 |
| Right to Continuation of Coverage |
|
2.42 |
| Member Input in the Development of
Plan Policies |
|
2.49 |
| Consent To Release Information |
|
2.49 |
| General Provisions |
|
2.50 |
| Non-English Speaking Enrollee |
|
2.51 |
| |
|
|
| PRESCRIPTION BENEFIT PROGRAM |
|
|
| Benefit Program Description |
|
3.3 |
| Partial list of participating pharmacies |
|
3.5 |
| Generic Drug Q&A; |
|
3.6 |
| |
|
|
