Section 5 – MEDICAL PLAN BENEFIT
- 5.1 CALENDAR YEAR DEDUCTIBLE
- 5.2 PERCENTAGE PAYABLE
- 5.3 ANNUAL OUT-OF-POCKET LIMIT
- 5.4 PREFERRED PROVIDER PROGRAM
- 5.5 HOSPITAL EMERGENCY ROOM
- 5.6 INPATIENT HOSPITAL SERVICES
- 5.7 OUTPATIENT HOSPITAL SERVICES
- 5.8 SURGICAL SERVICES
- 5.9 SKILLED NURSING FACILITY OR EXTENDED CARE FACILITY
- 5.10 PREADMISSION TESTING
- 5.11 TRANSPORTATION AND EXPENSES FOR MEDICALLY NECESSARY TREATMENT
- 5.12 HOSPICE CARE
- 5.13 PREVENTIVE HEALTH CARE
- 5.14 PROFESSIONAL SERVICES AND SUPPLIES
- 5.15 HEARING LOSS BENEFIT
- 5.16 HOME HEALTH CARE BENEFIT
- 5.17 TREATMENT FOR MENTAL ILLNESS/SUBSTANCE ABUSE
- 5.18 MEDICARE PART B REIMBURSEMENT
- 5.19 HEALTHREACH DISEASE MANAGEMENT PROGRAMS
- 5.20 HEALTH REIMBURSEMENT ARRANGEMENT (HRA)
Your Medical Plan Benefit provides comprehensive coverage of Covered Expenses incurred for an Illness or Injury, and is subject to a deductible and coinsurance provision that applies to each Participant each calendar year. The Medical Plan benefit has been structured to provide an incentive to use Preferred Providers for hospital treatment, office visits, and supplies.
You should also know the limitations and exclusions of the Medical Plan Benefit. Some of these limitations and exclusions are described with the Plan benefits; others are described in Section 7, EXCLUSIONS AND GENERAL LIMITATIONS.
PLEASE NOTE THAT COVERAGE FOR MEDICARE-ELIGIBLE RETIRED PARTICIPANTS AND THEIR SPOUSES AND DEPENDENTS IS DESCRIBED IN A SEPARATE TEAMSTAR BOOKLET, AND SECTIONS 5.1 THROUGH 5.20 DO NOT APPLY.