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Accident and Health Product Filing

Return to Health Information for Insurers

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Cover Page

04/11/2013

Individual- Table of Contents

04/01/2013

Group- Table Of Contents

04/01/2013

Definitions

04/11/2013

How This Coverage Works (Introduction, Selecting a Primary Care Provider, Preauthorization, Medically Necessary)

04/11/2013

Access to Care and Transitional Care (Referrals, Specialty Care Provider as PCP)

04/11/2013

Cost-Sharing Expenses and Allowed Amount

04/15/2013

Individual-Who is Covered (Eligibility)

04/19/2013

Group-Who is Covered (Eligibility)

04/15/2013

Primary and Preventive Care (Well-Baby and Well-Child Care, Adult Annual Physical Examinations, Adult Immunizations, Well-Woman Examinations, Mammograms, Family Planning & Reproductive Health Services, Bone Mineral Density Measurements or Testing, Screening for Prostate Cancer)

04/11/2013

Pre-Hospital Emergency Medical Services

04/11/2013

Emergency and Urgent Care

04/11/2013

Outpatient and Professional Services (Acupuncture, Advanced Imaging Services, Allergy Testing and Treatment, Ambulatory Surgery Center, Chemotherapy, Chiropractic Services, Dialysis, Habilitation Services, Home Health Care, Interruption of Pregnancy, Infertility Treatment, Infusion Therapy, Laboratory Procedures, Diagnostic testing and Radiology Services, Maternity and Newborn Care, Medications for Use in the Office, Office Visits, Outpatient Hospital Services, Preadmission Testing, Rehabilitation Services, Second Opinions, Surgical Services, Oral Surgery, Reconstructive Breast Surgery, Other Reconstructive and Corrective Surgery, Transplants)

04/11/2013

Additional Benefits (Autism Spectrum Disorder, Diabetic Equipment, Supplies and Self-Management Education, Durable Medical Equipment and Braces, Hearing Aids, Hospice, Prosthetics, Orthotics)

04/11/2013

Inpatient Services (Hospital Services, Observation Services, Inpatient Medical Services, Inpatient Stay for Maternity Care, Inpatient Stay for Mastectomy Care, Autologous Blood Banking Services, Rehabilitation Services, Skilled Nursing Facility, End of Life Care)

04/11/2013

Mental Health and Substance Use

04/11/2013

Prescription Drugs

04/11/2013

Wellness

04/11/2013

Pediatric Vision

04/11/2013

Pediatric Dental

04/11/2013

Exclusions

04/11/2013

Claims Determinations

04/11/2013

Grievance

04/19/2013

Utilization Review

04/19/2013

External Appeal

04/11/2013

Coordination of Benefits (Group Only)

04/11/2013

Termination

04/16/2013

Extension of Benefits

04/11/2013

Continuation (Group Only - includes Temporary Suspension Rights for Members of Armed Forces)

04/11/2013

Conversion

04/11/2013

Temporary Suspension Rights for Members of the Armed Forces (Individual Only)

04/01/2013

General Provisions (Incontestability, Legal Actions, Subrogation, Unilateral Modification)

04/15/2013

Schedule of Benefits

04/11/2013

Age 29 Rider

04/29/2013

Out-of-Network Rider

04/15/2013

Family Planning Rider

04/11/2013

Domestic Partner Rider

04/11/2013

Member Handbook

05/28/2013

Updated 05/28/2013