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Benefits Summary
Premier Plan
In-Network Service
Out-Of-Network Service
In-Network Benefits
Prescription Drug Benefits
Out-of-Network Benefits
Out-of-Pocket Expense Maximum
Out-of-Area Plans
Basic Plan
In-Network Service
Out-of-Network Service
In-Network Plan Benefits
Prescription Drug Benefits
Out-of-Pocket Expense Maximum
Core Plan
In-Network Service
Out-of-Network Service
In-Network Plan Benefits
Prescription Drug Benefits
Out-of-Pocket Expense Maximum
Wrap-Around Plan
Medicare
Networks
Prescription Drug Benefits
Network Service
Maximum Benefit
Dental Plan
In-Network Service
Out-of-Network Service
Vision Plan
Other Vision Plan Benefits
What Is Covered
Explanation of Terms
Medically Necessary Care
Experimental or Investigational Treatment or Care
Reasonable and Customary Charges
Approving Your Care
If You Do Not Get Approval
Approval If You Have Other Coverage
Finding and In-Network Provider
Your Medical Id Care
Covered Medical Services
Routine Preventitive Care (In-Network Only)
Lifestyle Management Programs
Disease Management Program for Chronic Conditions
Case Management for Catastrophic Conditions
Maternity Care
Family Planning
Care from a Specialist
Outpatient Surgery
Second Opinions
Emergency and Urgent Care
Urgent Care
Hospital Care
Room and Board
Other Hospital Expenses
Emergency Room Expenses
Pre-Admission Expenses
Physician Vists
Surgical Costs
Ambulance Service
Other Medical Services
Private Duty Nursing
Cancer Therapy
Dental Treatment
Other Non-Hospital Services and Supplies
Non-Routine Care and Services
Skilled Nursing Facility
Home Healthy Care
Hospice Care
Transplant Surgery
What is Covered Under the Behavioral Health Program
The Member Assistance Program (MAP)
Approval for Behavioral Health Care
What Treatment Is Covered
Plan Limits
The Prescription Drug Program
Types of Prescription Drugs
Prescription Brand Deductible and Generic Substitution
Purchasing Prescriptions
Using an In-Network Retail Pharmacy
Using an Out-of-Network Retail Pharmacy
Using the Mail Service
MILA/CVS Caremark Maintenance Choice Program
Regular Mail Order Service or Maintenance Choice
When You Must Use the Mail Service
Exceptions to Mandatory Mail Service
Paying for Your Prescription Drugs through the Mail Service Pharmacy
Covered Prescription Drugs
Specialty Medications
Quantity Restrictions on Covered Medications
When to Get Prior Approval for a Prescription
When Covered by More than One Prescription Drug Plan
The MILA Dental Plan
Dental Benefit Payable Under the Plan
Covered Dental Services
Obtaining a Pre-Treatment Estimate
When to Request a Pre-Treatment Estimate
In Case of a Dental Emergency
Limitations on Covered Dental Services
The MILA Vision Plan
The EyeMed Network
Using In-Network Providers
Using Out-of-Network Providers
Additional Discounts
Laser Vision Correction Procedure
Mail Order Contact Lens Replacement Program
What is Not Covered
Medical Expensese Not Covered Under the Plan
Charges Not Covered in the Behavioral Health Program
Charges Not Covered in the Prescription Drug Program
Dental Charges and Services Not Covered Under the Plan
Vision Charges and Services Not Covered Under the Plan
Coordination of Benefits
How Coordination Works
Which Plan Pays Benefits First
If You Are Overpaid Benefits
Third Party Reimbursement and Subrogation
Waiver of Benefits
Participation Under the Plan
Who Is Eligible
Your Eligible Dependents
Your Dependent as Determined by a QMCSO or a NMSN
When You Become Covered Under the Plan
Non-Bargaining Unit Order
If You Are Eligible for Medicare Benefits
Medicare for Pensioners
If You Become Disabled
ID Cards: Proof of Coverage
When Coverage Ends
Termination of MILA Coverage Because of Active Duty Military Service
Continued Coverage Under COBRA
Notice of a Qualifying Event
Making a COBRA Election
Paying for COBRA Coverage
What COBRA Coverage Provides
When COBRA Coverage Ends
Pensioner Benefits
Members Who Retired Prior to October 1, 2004
Members Who Retire on a Disability Pension
Members Who Leave the Industry After September 30, 2004 Without Retiring
Members Who Retire at Any Age and are Not Eligible...
Members Who Retire At Age 57 or Younger with 25 or More Years of Pension Service
Members Who Retire After Attaining the Age of 58 and Before Age 62...
Members Who Retire After Attaining the Age of 62 with 25 or More Years...
Members Who Retire at the Age of 65 or Older with 25 or More Years...
Members Who Retire with Less than 25 Years of Pension Service
Pensioners Who Return to Active Service in the Industry
If You are Eligible for Medicare When You Retire
About Medicare
How Traditional Medicare Works
You Must Enroll in Medicare...
Medicare Advantage Plans
Claims and Appeals
Claims For Benefits
Chart of Time Limits in Appealing a Claim
Authorized Representatives
Definitions of Types of Claims
Urgent Care Claim
Non-Urgent Pre-Service Claim
Concurrent Care Claim
Post Service Claim
Timing for Initial Benefit Determination
Urgent Care Claim
Non-Urgent Pre-Service Claim
Concurrent Care Claim
Post Service Claim
When/Where to File Claims
Claims for Out-of-Network Benefits
The Prescription Drug Program
Pharmacy Coverage
Notice Of Decision
Claim Appeal Procedures
Review Process
Timing of Notice of Decision on Appeal
Urgent Care Claim
Non-Urgent Pre-Service and Concurrent Claim
Post Service Claim
Post Service Appeals of Eligibility
Notice of Decision on Review After Appeal
Limitation on When a Lawsuit May Begin
Your Rights Under ERISA
Assignment of Benefits
Qualified Medical Child Support Order
Your Rights Under ERISA
Administrative Information
Administrative Information Chart
MILA Resources
Glossary
Label
Mental Health and Substance Abuse Coverage
File claims for mental health and substance abuse benefits by sending your claim to:
Cigna Behavioral Health Corporation
NBC Tower, 24th Floor
455 North Cityfront Plaza Drive
Chicago, IL 60611-5322
