Certification is not required for those participants having Medicare or other primary coverage, unless the service is not covered by the primary carrier. For additional information, see the Medical Management and Utilization Review section.
Identification Cards For protection from identity theft, the enrollee’s Social Security number is not on his health insurance or prescription drug identification card. The health insurance identification card includes important information and should be presented when receiving medical services or supplies. The prescription drug identification card should be presented when purchasing prescription drugs. These identification cards provide important addresses and phone numbers.
Lifetime Maximum The maximum amount payable for each participant is $1,000,000. This lifetime maximum applies to each covered employee and dependent under the Plan. This maximum applies to a participant’s entire lifetime, regardless of the participant’s coverage status, i.e., employee, retiree, COBRA participant, surviving spouse, or dependent. This maximum will be cross applied between all coverage types. This maximum also applies regardless of any break in coverage or service.
Integration of Benefits The Plan includes integration of benefits for Plan maximums between in-network and out-of- network benefits. This means that lifetime maximums, annual maximums, and maximums which apply per day or visit will be cross applied, regardless of whether the provider is participating or non-participating. Coverage maximums will also be cross applied between all coverage types.