Page 3 - 2021 Medical Plan SPD
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Summary Plan Description Table of Contents
Summary Plan Description ...................................................................... 1
United Healthcare Services, Inc. .............................................................. 1
Introduction to Your SPD ......................................................................... 3
Your Responsibilities ............................................................................... 4
Claims Administrator and Plan Sponsor Responsibilities .................... 6
Schedule of Benefits ................................................................................ 8
Section 1: Covered Health Care Services ............................................. 38
Section 2: Exclusions and Limitations .................................................. 58
Section 3: When Coverage Begins ........................................................ 70
Section 4: When Coverage Ends ........................................................... 74
Section 5: How to File a Claim ............................................................... 81
Section 6: Questions, Complaints and Appeals ................................... 83
Section 7: Coordination of Benefits ...................................................... 90
Section 8: General Legal Provisions ..................................................... 98
Section 9: Defined Terms ..................................................................... 110
Amendments, Riders and Notices (As Applicable)
Amendment: Real Appeal
Amendment: Wellness
Clinical Programs and Resources
Federal Notice
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