2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 3
Amendment or Termination of Health Care Plan .................................................................................18
MISCELLANEOUS INFORMATION .................................................................................................................19
Affiliated Companies ............................................................................................................................19
Assignment of Benefits .........................................................................................................................19
Clerical Error ........................................................................................................................................19
Conformity with Applicable Laws ..........................................................................................................19
Contributions ........................................................................................................................................19
Cost and Funding of the Health Care Plan ...........................................................................................19
Employer ..............................................................................................................................................19
Interpretation of this Document ............................................................................................................19
No Contract of Employment .................................................................................................................20
Release of Information .........................................................................................................................20
Unclaimed Property ..............................................................................................................................20
Workers’ Compensation .......................................................................................................................20
Minimum Essential Coverage ...............................................................................................................21
HIPAA PRIVACY PRACTICES .........................................................................................................................22
HIPAA SECURITY PRACTICES.......................................................................................................................24
GENERAL HEALTH CARE PLAN INFORMATION ..........................................................................................25
GROUP MEDICAL PLAN..................................................................................................................................28
GENERAL OVERVIEW OF THE MEDICAL PLAN ...........................................................................................28
Non-Participating Provider Exceptions .................................................................................................28
Costs ....................................................................................................................................................29
Coinsurance .........................................................................................................................................29
Copay ...................................................................................................................................................29
Deductible ............................................................................................................................................29
Out-of-Pocket Maximum .......................................................................................................................29
Integration of Deductibles and Out-of-Pocket Maximums ....................................................................30
Medical Expense Audit Bonus..............................................................................................................30
MEDICAL MANAGEMENT AND PRECERTIFICATION PROGRAM ...............................................................31
How the Program Works ......................................................................................................................31
Penalty .................................................................................................................................................32
Concurrent Inpatient Review ................................................................................................................33
To File a Complaint or Request an Appeal to a Non-Certification ........................................................33
Meritain Health 24x7 Nurse Line ..........................................................................................................33
MEDICAL SCHEDULE OF BENEFITS: VALUE MEDICAL PLAN ....................................................................35
MEDICAL SCHEDULE OF BENEFITS: PREMIER MEDICAL PLAN ...............................................................39
PRESCRIPTION DRUG SCHEDULE OF BENEFITS ......................................................................................43
PRESCRIPTION DRUG CARD PROGRAM .....................................................................................................44
ELIGIBLE MEDICAL EXPENSES .....................................................................................................................46
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