The Plan provides an extensive package of benefits that help you pay for everyday medical costs and wellness services, as well as expenses resulting from illness or injury. Both Plan I and Plan II pay toward covered Physician charges, Hospital and surgical expenses, laboratory and radiology charges, mental health and substance abuse treatment and prescription drugs, among other medical expenses. Plan I and Plan II differ, however, in certain aspects with regard to the extent of the benefits available for these expenses.
The Plan’s benefits are subject to the exclusions and limitations described throughout this SPD. Services also must be Medically Necessary in order to be covered. As such, the Plan’s benefits may not cover all treatment prescribed by your Physician.
- The Plan’s Provider Networks Offer Savings and Convenience
- The Plan’s Hospital Benefit Is Limited to Care From In-network Hospitals Only
- The Industry Health Network (TIHN)
- Comprehensive Out-of-pocket Maximum
- Hospital Benefits
- Medical Benefits
- Optum’s Quit for Life® Program
- Prescription Drug Benefits
- Dental Benefits
- Vision Benefits
- Life Insurance Benefits
- Accidental Death and Dismemberment (AD&D) Benefits
- General Exclusions