Table of Contents
Important Information..................................................................................................................4
Important Notices ..........................................................................................................................6
How To File Your Claim ...............................................................................................................7
Eligibility - Effective Date .............................................................................................................7 Employee Insurance ...............................................................................................................................................7 Waiting Period........................................................................................................................................................8 Dependent Insurance ..............................................................................................................................................8 Cigna Vision ...................................................................................................................................9 The Schedule ..........................................................................................................................................................9 Covered Expenses ................................................................................................................................................11 Expenses Not Covered .........................................................................................................................................11
Exclusions and General Limitations ..........................................................................................11
Coordination of Benefits..............................................................................................................12
Payment of Benefits .....................................................................................................................14
Termination of Insurance............................................................................................................15 Employees ............................................................................................................................................................15 Dependents ...........................................................................................................................................................15 Federal Requirements .................................................................................................................15 Qualified Medical Child Support Order (QMCSO) .............................................................................................15 Effect of Section 125 Tax Regulations on This Plan ............................................................................................16 Eligibility for Coverage for Adopted Children.....................................................................................................17 Group Plan Coverage Instead of Medicaid...........................................................................................................17 Requirements of Family and Medical Leave Act of 1993 (as amended) (FMLA) ...............................................17 Uniformed Services Employment and Re-Employment Rights Act of 1994 (USERRA) ....................................17 Claim Determination Procedures under ERISA ...................................................................................................18 Appointment of Authorized Representative .........................................................................................................18 Medical - When You Have a Complaint or an Appeal .........................................................................................18 COBRA Continuation Rights Under Federal Law ...............................................................................................20 ERISA Required Information ...............................................................................................................................23
Definitions.....................................................................................................................................24
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