Page 36 - Salus Group Plan Doc SPD
P. 36
APPENDIX A
BENEFIT PROGRAMS OFFERED: MEDICAL/PRESCRIPTION DRUG, SHORT-TERM
DISABILITY INSURANCE COVERAGE, LONG-TERM DISABILITY INSURANCE COVERAGE,
GROUP TERM LIFE INSURANCE, ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE
COVERAGE AND VOLUNTARY DENTAL PLAN & VOLUNTARY VISION PLAN.
BENEFIT PROGRAM/ NAME OF INSURER/ POLICY OR CLAIMS
BENEFITS
EFFECTIVE DATE CLAIMS CONTRACT PROVIDED ELIGIBILITY PROCEDURE
OF COVERAGE ADMINISTRATOR NUMBER(S) & BENEFITS
See Plan/SPD See Plan/SPD See Plan/SPD
GROUP MEDICAL BLUE CARE 00400510/000 and Certificates and Certificates and Certificates
INSURANCE NETWORK OF 1/0001 of Insurance and of Insurance and of Insurance
MICHIGAN other benefit other benefit and other
materials
benefit
materials
HMO provided by provided by materials
INSURER/CLAIMS Insurer. Insurer. provided by
ADMINISTRATOR
01/01/2012 Insurer.
See Plan/SPD See Plan/SPD See Plan/SPD
SHORT-TERM LINCOLN FINANCIAL 00001009687 and Certificates and Certificates and Certificates
DISABILITY BENEFITS GROUP (LINCOLN 2 of Insurance and of Insurance and of Insurance
NATIONAL LIFE) other benefit other benefit and other
materials
benefit
materials
01/01/2012 provided by provided by materials
INSURER/CLAIMS Insurer. Insurer. provided by
ADMINISTRATOR Insurer.
See Plan/SPD See Plan/SPD See Plan/SPD
LONG-TERM LINCOLN FINANCIAL 00001007636 and Certificates and Certificates and Certificates
DISABILITY BENEFITS GROUP (LINCOLN 9 of Insurance and of Insurance and of Insurance
NATIONAL LIFE) other benefit other benefit and other
materials
materials
benefit
01/01/2012 provided by provided by materials
INSURER/CLAIMS Insurer. Insurer. provided by
ADMINISTRATOR Insurer.
See Plan/SPD See Plan/SPD See Plan/SPD
GROUP TERM LIFE LINCOLN FINANCIAL 00001007637 and Certificates and Certificates and Certificates
INSURANCE GROUP (LINCOLN 0 of Insurance and of Insurance and of Insurance
BENEFITS NATIONAL LIFE) other benefit other benefit and other
materials materials benefit
provided by provided by materials
01/01/2012 INSURER/CLAIMS Insurer. Insurer. provided by
ADMINISTRATOR Insurer.
36
