Table of Contents

Board of Trustees

Health Services Staff

SECTION ONE:
Important Phone Numbers

SECTION TWO:
Eligibility For Coverage

Continuing Your Coverage go

SECTION THREE:
Life Events

SECTION FOUR:
Your Medical Benefits (Level I)

Summary of Benefits go

How Your Medical Plan Works go

Hospitalization and Surgery go

Wellness Benefits go

Extended Care Benefits go

Mental Health and Chemical Dependency go

Prescription Drug Benefits go

Other Covered Medical Expenses go

SECTION FOUR A:
Your Enhanced Medical Benefits (Level I)

Summary of Benefits go

How Your Medical Plan Works go

Hospitalization and Surgery go

Wellness Benefits go

Extended Care Benefits go

Mental Health and Chemical Dependency go

Prescription Drug Benefits go

Other Covered Medical Expenses go

SECTION FIVE:
Your Medical Benefits (Level II)

Summary of Benefits go

How Your Medical Plan Works go

Hospitalization and Surgery go

Wellness Benefits go

Extended Care Benefits go

Mental Health and Chemical Dependency go

Prescription Drug Benefits go

Other Covered Medical Expenses go

SECTION FIVE A:
Your Enhanced Medical Benefits (Level II)

Summary of Benefits go

How Your Medical Plan Works go

Hospitalization and Surgery go

Wellness Benefits go

Extended Care Benefits go

Mental Health and Chemical Dependency go

Prescription Drug Benefits go

Other Covered Medical Expenses go

SECTION SIX:
Dental Benefits

SECTION SEVEN:
Vision and Hearing Benefits

Vision Care go

Hearing Care go

SECTION EIGHT:
Life and Dismemberment Insurance and WA&S

Life Insurance go

Vested Death Benefit go

Accidental Death and Dismemberment Benefits go

Death and Dismemberment Benefits for Dependents go

Weekly Accident and Sickness Benefits go

SECTION NINE:
Legal Services

SECTION TEN:
Retiree Benefits

SECTION ELEVEN:
Filing Your Claims

SECTION TWELVE:
Important Information About Your Plan

Coordination of Benefits go

SECTION THIRTEEN:
Members' Assistance Program

Your ERISA Rights go

SECTION FOURTEEN:
Privacy Requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

SECTION 15:
Enhanced Level Benefits Requirements