2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 4
PRESCRIPTION DRUG CARD PROGRAM .....................................................................................................45
ELIGIBLE MEDICAL EXPENSES .....................................................................................................................47
AETNA INSTITUTE OF EXCELLENCE (IOE) PROGRAM...............................................................................58
Transplant Expenses ............................................................................................................................58
Covered Transplant Expenses .............................................................................................................58
Limitations ............................................................................................................................................60
Travel and Lodging Expenses ..............................................................................................................60
ALTERNATE BENEFITS ..................................................................................................................................61
GENERAL EXCLUSIONS AND LIMITATIONS .................................................................................................62
CLAIM AND APPEAL PROCEDURES .............................................................................................................67
DEFINITIONS ...................................................................................................................................................73
DENTAL AND VISION PLAN ............................................................................................................................82
VISION SCHEDULE OF BENEFITS .................................................................................................................83
DENTAL SCHEDULE OF BENEFITS ...............................................................................................................84
ELIGIBLE DENTAL EXPENSES.......................................................................................................................85
Deductible ............................................................................................................................................85
Date Expenses are Incurred.................................................................................................................85
Alternative Treatment ...........................................................................................................................85
Class A-Preventive Services: ...............................................................................................................85
Class B-Basic Services: .......................................................................................................................86
Class C-Major Services: .......................................................................................................................86
Class D-Orthodontic Services ..............................................................................................................87
DENTAL AND VISION EXCLUSIONS AND LIMITATIONS ..............................................................................88
DENTAL AND VISION CLAIM AND APPEAL PROCEDURES ........................................................................90
DEFINITIONS ...................................................................................................................................................95
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