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Teachers & Staff
“A New Day... A New Way in Waukegan Public Schools... above and beyond!”
Restated: April 1, 2003
PLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION FOR WAUKEGAN PUBLIC SCHOOLS EMPLOYEE HEALTH AND DENTAL BENEFIT PLAN
TABLE OF CONTENTS
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INTRODUCTION
GENERAL PLAN INFORMATION
- ELIGIBILITY, FUNDING, EFFECTIVE DATE AND TERMINATION PROVISIONS
- Funding
- Pre-Existing Conditions
- Enrollment
- Effective Date
- Termination of Coverage
ANNUAL ENROLLMENT
- SCHEDULE OF BENEFITS
- Deductibles
- Prescription Drug Benefit
- Dental Benefits
- Weight Loss and Smoking Cessation Programs
- MEDICAL BENEFITS
- Hospital Care
- Coverage of Pregnancy
- Skilled Nursing Facility Care
- Physician Care
- Private Duty Nursing Care
- Home Health Care Services and Supplies
- Hospice Care Services and Supplies
- Other Medical Services and Supplies
COST MANAGEMENT SERVICES
DEFINED TERMS
PLAN EXCLUSIONS
PRESCRIPTION DRUG BENEFITS
- DENTAL BENEFITS
- Dental Charges
- Predetermination of Benefits
- Extension of Benefits
- Exclusions
HOW TO SUBMIT A CLAIM
COORDINATION OF BENEFITS
THIRD PARTY RECOVERY PROVISION
COBRA CONTINUATION OPTIONS
RESPONSIBILITIES FOR PLAN ADMINISTRATION
HIPAA PRIVACY
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