2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 3
Authority to Make Decisions .................................................................................................................19
Amendment or Termination of Health Care Plan .................................................................................19
MISCELLANEOUS INFORMATION .................................................................................................................20
Affiliated Companies ............................................................................................................................20
Assignment of Benefits .........................................................................................................................20
Clerical Error ........................................................................................................................................20
Conformity with Applicable Laws ..........................................................................................................20
Contributions ........................................................................................................................................20
Cost and Funding of the Health Care Plan ...........................................................................................20
Employer ..............................................................................................................................................20
Interpretation of this Document ............................................................................................................20
No Contract of Employment .................................................................................................................21
Release of Information .........................................................................................................................21
Unclaimed Property ..............................................................................................................................21
Workers’ Compensation .......................................................................................................................21
Minimum Essential Coverage ...............................................................................................................22
HIPAA PRIVACY PRACTICES .........................................................................................................................23
HIPAA SECURITY PRACTICES.......................................................................................................................25
GENERAL HEALTH CARE PLAN INFORMATION ..........................................................................................26
GROUP MEDICAL PLAN..................................................................................................................................29
GENERAL OVERVIEW OF THE MEDICAL PLAN ...........................................................................................29
Non-Participating Provider Exceptions .................................................................................................29
Costs ....................................................................................................................................................30
Coinsurance .........................................................................................................................................30
Copay ...................................................................................................................................................30
Deductible ............................................................................................................................................30
Out-of-Pocket Maximum .......................................................................................................................30
Integration of Deductibles and Out-of-Pocket Maximums ....................................................................31
Medical Expense Audit Bonus..............................................................................................................31
MEDICAL MANAGEMENT AND PRECERTIFICATION PROGRAM ...............................................................32
How the Program Works ......................................................................................................................32
Penalty .................................................................................................................................................33
Concurrent Inpatient Review ................................................................................................................34
To File a Complaint or Request an Appeal to a Non-Certification ........................................................34
Meritain Health 24x7 Nurse Line ..........................................................................................................34
MEDICAL SCHEDULE OF BENEFITS: VALUE MEDICAL PLAN ....................................................................36
MEDICAL SCHEDULE OF BENEFITS: PREMIER MEDICAL PLAN ...............................................................40
PRESCRIPTION DRUG SCHEDULE OF BENEFITS ......................................................................................44
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