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BS 2008 Regular SPD Final CD

BS 2008 Regular SPD Final CD

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Published by: jimmynphylliss on Sep 14, 2008
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10/15/2011

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Summary Plan Description
Effective January 1, 2008
BON SECOURS HEALTH SYSTEM, INC.
Health Plan
Benefits
Choice 08
 
TABLE OF CONTENTS
INTRODUCTION.........................................................................................................................................1HEALTH PLAN PARTICIPATION...................................................................................................................2PLAN MEMBERSHIP........................................................................................................................2CHANGING YOUR HEALTH PLAN COVERAGE.............................................................................4AMENDMENT AND TERMINATION...............................................................................................7COST OF COVERAGE.....................................................................................................................8THE MEDICAL PLAN..................................................................................................................................10MEDICAL PLAN OPTIONS............................................................................................................10HOW THE MEDICAL PLAN PAYS BENEFITS..................................................................................10COVERED EXPENSES.....................................................................................................................15WHAT THE PLAN DOES NOT COVER..........................................................................................36UNITEDHEALTH ALLIES................................................................................................................40THE DENTAL PLAN....................................................................................................................................42HOW THE DENTAL PLAN PAYS BENEFITS...................................................................................42COVERED EXPENSES....................................................................................................................44WHAT THE DENTAL PLAN DOES NOT COVER............................................................................48THE VISION PLAN.....................................................................................................................................50HOW THE VISION PLAN PAYS BENEFITS.....................................................................................50PLAN BENEFITS............................................................................................................................51WHAT THE VISION PLAN DOES NOT COVER.............................................................................52FLEXIBLE SPENDING ACCOUNTS.............................................................................................................53INTRODUCTION..........................................................................................................................53FLEXIBLE SPENDING ACCOUNT OVERVIEW...............................................................................53ELECTING FSA BENEFITS..............................................................................................................53HEALTHCARE SPENDING ACCOUNT..........................................................................................54DEPENDENT CARE SPENDING ACCOUNT..................................................................................56REIMBURSEMENTS FROM YOUR FSAs.........................................................................................58HEALTHCARE REIMBURSEMENT ACCOUNT PLAN.....................................................................59PREMIUM PAYMENT PLAN.......................................................................................................................60INTRODUCTION..........................................................................................................................60PREMIUM PAYMENT PLAN OVERVIEW........................................................................................60ELECTION PROCEDURES.............................................................................................................60
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CLAIMS AND APPEALS..............................................................................................................................61CLAIM INFORMATION FOR THE MEDICAL PLAN.......................................................................61CLAIM INFORMATION FOR THE DENTAL PLAN.........................................................................67CLAIM INFORMATION FOR THE VISION PLAN...........................................................................69APPEALS OF ELIGIBILITY ISSUES..................................................................................................70COORDINATION OF BENEFITS.................................................................................................................71REIMBURSEMENT AND SUBROGATION..................................................................................................74REIMBURSEMENT AND SUBROGATION UNDER THE MEDICAL PLAN......................................74REIMBURSEMENT AND SUBROGATION UNDER THE DENTAL PLAN........................................76COBRA CONTINUATION COVERAGE......................................................................................................77IMPORTANT NOTICE FROM BON SECOURS HEALTH SYSTEM, INC. ABOUT YOUR PRESCRIPTIONDRUG COVERAGE AND MEDICARE............................................................................................79NOTICE OF RIGHTS UNDER THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT(HIPAA).........................................................................................................................................81NOTICE OF PRIVACY PRACTICES FOR THE BON SECOURS HEALTH SYSTEM, INC. MEDICAL PLAN,DENTAL PLAN, VISION PLAN, MEDICAL REIMBURSEMENT ACCOUNT & HEALTHREIMBURSEMENT ACCOUNTS....................................................................................................81YOUR RIGHTS UNDER ERISA...................................................................................................................84ADMINISTRATIVE INFORMATION............................................................................................................86
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