Page 3 - Aegion PPO 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 ............................................................................................................................................. 26
ELIGIBILITY, ENROLLMENT, TERMINATION AND CONTINUATION ................................................... 36
HOW YOUR PLAN WORKS ...................................................................................................................... 45
HEALTH CARE MANAGEMENT – PRECERTIFICATION ....................................................................... 48
COVERED SERVICES ............................................................................................................................... 57
EXCLUSIONS ............................................................................................................................................ 72
CLAIMS PAYMENT ................................................................................................................................... 76
GENERAL PROVISIONS ........................................................................................................................... 84
COORDINATION OF BENEFITS ............................................................................................................... 87
YOUR RIGHT TO APPEAL ....................................................................................................................... 96
HEALTH BENEFITS COVERAGE UNDER FEDERAL LAW ................................................................. 100
ERISA INFORMATION AND STATEMENT OF ERISA RIGHTS............................................................ 102
IT’S IMPORTANT WE TREAT YOU FAIRLY .......................................................................................... 106
GET HELP IN YOUR LANGUAGE .......................................................................................................... 107
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BENEFIT BOOKLET .................................................................................................................................... 2
TABLE OF CONTENTS ............................................................................................................................... 3
MEMBER RIGHTS AND RESPONSIBILITIES ............................................................................................ 4
SCHEDULE OF BENEFITS ......................................................................................................................... 6
DEFINITIONS ............................................................................................................................................. 26
ELIGIBILITY, ENROLLMENT, TERMINATION AND CONTINUATION ................................................... 36
HOW YOUR PLAN WORKS ...................................................................................................................... 45
HEALTH CARE MANAGEMENT – PRECERTIFICATION ....................................................................... 48
COVERED SERVICES ............................................................................................................................... 57
EXCLUSIONS ............................................................................................................................................ 72
CLAIMS PAYMENT ................................................................................................................................... 76
GENERAL PROVISIONS ........................................................................................................................... 84
COORDINATION OF BENEFITS ............................................................................................................... 87
YOUR RIGHT TO APPEAL ....................................................................................................................... 96
HEALTH BENEFITS COVERAGE UNDER FEDERAL LAW ................................................................. 100
ERISA INFORMATION AND STATEMENT OF ERISA RIGHTS............................................................ 102
IT’S IMPORTANT WE TREAT YOU FAIRLY .......................................................................................... 106
GET HELP IN YOUR LANGUAGE .......................................................................................................... 107
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