Summary Plan Description

Download a PDF of the SPD

Table of Contents

1. Cover Page
2. Participant Relief Due to the Declared National Emergency Effective March 1, 2020
3. Introduction
4. Eligibility
   1. Active Eligibility
   2. Eligibility Buy-Up
   3. Retiree Eligibility
   4. Dependent Eligibility
   5. COBRA Continuation Coverage
   6. Self-Payment for Surviving Spouses and Dependents
   7. Family Medical Leave Act (FMLA)
   8. Rescission of Eligibility
5. Medical Coverage
   1. Medical Benefits
   2. LiveHealth Online
   3. Hospital Benefits
   4. Medical and Hospital Benefit Exclusions
   5. Member Assistance Program (MAP)
   6. Mental Health and Substance Abuse Benefits
   7. Prescription Drug Benefits
   8. Vision Benefits
   9. Dental Benefits
   10. Health Maintenance Organizations (HMOs)
   11. Life, Weekly Disability and AD&D Benefits
   12. Retiree Death Benefit
6. Medical Benefits for Medicare Retirees
   1. Full Health Plan Options
   2. Supplemental Plan Options
7. General Provisions
   1. Coordination of Benefits
   2. Filing a Claim for Benefits
   3. Claim Review and Appeals Procedures
   4. Privacy Statement
   5. Statement of ERISA Rights
   6. Notice of Nondiscrimination and Accessibility Requirements
   7. Facts About Your Plan
8. General Information
9. Glossary of Terms