Page 3 - Aegion Value Plan SPDs
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TABLE OF CONTENTS
BENEFIT BOOKLET .................................................................................................................................... 2
TABLE OF CONTENTS ............................................................................................................................... 3
MEMBER RIGHTS AND RESPONSIBILITIES ............................................................................................ 4
SCHEDULE OF BENEFITS ......................................................................................................................... 6
DEFINITIONS ............................................................................................................................................. 20
ELIGIBILITY, ENROLLMENT, TERMINATION AND CONTINUATION ................................................... 30
HOW YOUR PLAN WORKS ...................................................................................................................... 39
HEALTH CARE MANAGEMENT – PRECERTIFICATION ....................................................................... 42
COVERED SERVICES ............................................................................................................................... 51
EXCLUSIONS .......................................................................................................................................... 666
CLAIMS PAYMENT ................................................................................................................................. 700
GENERAL PROVISIONS ......................................................................................................................... 788
COORDINATION OF BENEFITS ............................................................................................................. 811
YOUR RIGHT TO APPEAL ..................................................................................................................... 900
HEALTH BENEFITS COVERAGE UNDER FEDERAL LAW ................................................................. 944
ERISA INFORMATION AND STATEMENT OF ERISA RIGHTS............................................................ 966
IT’S IMPORTANT WE TREAT YOU FAIRLY ........................................................................................ 1000
GET HELP IN YOUR LANGUAGE ........................................................................................................ 1011
3
BENEFIT BOOKLET .................................................................................................................................... 2
TABLE OF CONTENTS ............................................................................................................................... 3
MEMBER RIGHTS AND RESPONSIBILITIES ............................................................................................ 4
SCHEDULE OF BENEFITS ......................................................................................................................... 6
DEFINITIONS ............................................................................................................................................. 20
ELIGIBILITY, ENROLLMENT, TERMINATION AND CONTINUATION ................................................... 30
HOW YOUR PLAN WORKS ...................................................................................................................... 39
HEALTH CARE MANAGEMENT – PRECERTIFICATION ....................................................................... 42
COVERED SERVICES ............................................................................................................................... 51
EXCLUSIONS .......................................................................................................................................... 666
CLAIMS PAYMENT ................................................................................................................................. 700
GENERAL PROVISIONS ......................................................................................................................... 788
COORDINATION OF BENEFITS ............................................................................................................. 811
YOUR RIGHT TO APPEAL ..................................................................................................................... 900
HEALTH BENEFITS COVERAGE UNDER FEDERAL LAW ................................................................. 944
ERISA INFORMATION AND STATEMENT OF ERISA RIGHTS............................................................ 966
IT’S IMPORTANT WE TREAT YOU FAIRLY ........................................................................................ 1000
GET HELP IN YOUR LANGUAGE ........................................................................................................ 1011
3
