This Plan Document contains the official rules and regulations of the State and School Employees’ Health Insurance Plan (Plan). This Plan Document replaces and supersedes all previously issued Plan Documents, Summary Plan Descriptions, and Master Plan Documents. When there are changes in benefits, a notice explaining the details of the changes will be issued. Notices of changes to the health Plan and life insurance coverage may be included in the Plan’s Know Your Benefits newsletter.
Please take a moment to read through this booklet to become familiar with the information it contains. Keep this Plan Document as a reference guide for questions on life and health benefits.
The Plan offers two coverage choices for active employees, COBRA participants, and non- Medicare eligible retirees: Base Coverage and Select Coverage. Each coverage type is independent of the other. Lifetime maximums will be cross applied between all coverage types. Throughout this Plan Document, the term Plan refers to Base Coverage and Select Coverage unless otherwise noted.
The Plan includes a separate coverage level for Medicare eligible retirees, Medicare eligible surviving spouses, and Medicare eligible dependents of retirees and surviving spouses.
If you are, or will become in the next 12 months, a Medicare eligible retiree, Medicare eligible surviving spouse, or a Medicare eligible dependent of a retiree or surviving spouse, the availability of prescription drug coverage under Medicare will impact your prescription drug coverage, starting in January 2006. Please refer to the Retiree Eligibility and Medical Coverage Section for more details.
No verbal statements of any person will modify or otherwise affect the benefits or limitations and exclusions of the Plan. Nor shall any such statements convey or void any coverage, or increase or reduce any benefits under the Plan.
This Plan Document does not create, nor is it intended to provide an employment contract between the State of Mississippi and any employee.
As provided by Mississippi state law, the State and School Employees Health Insurance Management Board (Board) has complete authority to control, operate, and manage the Plan. The Department of Finance and Administration, Office of Insurance is authorized by law to provide day-to-day management of the Plan. The Board has provided full discretion to the Office of Insurance to determine eligibility status, interpret Plan benefits and rules, and determine whether a claim should be paid or denied according to the provisions of the Plan set forth in this Plan Document. The Board reserves the right to amend, reduce, or eliminate any part of the Plan at any time.