2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 4
AETNA INSTITUTE OF EXCELLENCE (IOE) PROGRAM ...............................................................................57
Transplant Expenses ............................................................................................................................57
Covered Transplant Expenses .............................................................................................................57
Limitations ............................................................................................................................................59
Travel and Lodging Expenses ..............................................................................................................59
ALTERNATE BENEFITS ..................................................................................................................................60
GENERAL EXCLUSIONS AND LIMITATIONS .................................................................................................61
CLAIM AND APPEAL PROCEDURES .............................................................................................................66
DEFINITIONS ...................................................................................................................................................72
DENTAL AND VISION PLAN ............................................................................................................................81
VISION SCHEDULE OF BENEFITS .................................................................................................................82
DENTAL SCHEDULE OF BENEFITS ...............................................................................................................83
ELIGIBLE DENTAL EXPENSES.......................................................................................................................84
Deductible ............................................................................................................................................84
Date Expenses are Incurred.................................................................................................................84
Alternative Treatment ...........................................................................................................................84
Class A-Preventive Services: ...............................................................................................................84
Class B-Basic Services: .......................................................................................................................85
Class C-Major Services: .......................................................................................................................85
Class D-Orthodontic Services ..............................................................................................................86
DENTAL AND VISION EXCLUSIONS AND LIMITATIONS ..............................................................................87
DENTAL AND VISION CLAIM AND APPEAL PROCEDURES ........................................................................89
DEFINITIONS ...................................................................................................................................................94
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