Health & Security Plan > SPD > Introduction

Summary Plan Description

Introduction

Two of the largest categories of medical expenses for the Employee Health Plan are hospitalization and surgery. To help control these expenses, the plan contracts with a medical review agency to administer the plan's medical review program.

The medical review program is designed to let you and your physician know whether certain admissions and surgeries are medically necessary before you undergo treatment and incur expenses. The medical review program includes the following:

  • Preadmission certification for inpatient hospital admissions.
  • Second surgical opinions for certain surgical procedures.
  • Medical case management for certain medical conditions.

Key Point

The medical review agency advises the plan on the medical necessity of a recommended inpatient hospital admission, surgery or ongoing treatment plan. To receive benefits, the services and supplies must be covered under this plan and you must be eligible when the services are provided.

You and your dependents must use the medical review program even if you have other insurance (except Medicare). Failure to use the medical review program may result in a reduction in benefits.