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Rods – General Provisions

Rods – General Provisions
    A. HEALTH BENEFITS
    (10) GENERAL PROVISIONS
    · Acceptance of Plan by providers, 78-028
     
    Administration, 07-0075, CA-0130
    · Bonus, health care,93-031
    · Coordination of benefits/copayment, 78-060
         –copayment fro spouse with coverage from employer, 98-017 
    · Cost containment, 88-024, 88-253, 11-0143 
         —formulary drug program with surcharge, 98-013 , 98-014, 02-002 CA-056, CA-072
         –hospital admission precertification,84-196, 88-253
         –implementation of network pharmacy program, 88-322, 88-403, 88-411
         –maintenance drug mail order program, CA-066
         –second surgical opinion,88-253
    · Excessive charges,78-254
    · Health maintenance organization (HMO), 81-411, 81-533, 88-302, 11-0143
    · Hold harmless provision,88-609, 88-667
         –beneficiary signs contract of adhesion, 84-531
         –deductible-must meet for hold harmless, 93-105
         –excessive charges, 84-260, 84-264, 84-412, 84-484, 84-583, 88-076, 98-048, CA-040
         –medical necessity, 84-280, 84-531, 88-043, 88-134, 88-335, 88-412, 88-449, 88-485, 88-486, 88-507, 88-509, 88-513, 88-520, CA-038, CA-044, 02-046, 07-0008, 07-0023
         –promulgation of rules, 84-264, 84-484, 84-702, 88-076, 88-253, 88-452, 88-505, 88-508, 88-558, 88-667
         –reimbursement of beneficiary’s payment, 84-264, 84-484, 88-105, 88-335
         –services not provided under Plan, 84-467, 84-602
    · Medicare, 102, 81-044
         –active employee over age 65, 78-020
         –beneficiary fails to enroll in Part A & B, Q&A H-12, 78-020, 81-044, 81-260, 84-103, 84-271, 84-448, 84-491, 84-497, 84-516, 84-542, 84-637, 84-679, 88-205, 88-467, 88-644, 88-650, 88-659, CA-022, CA-071
         –beneficiary receives SSDI benefits, 88-650, CA-071
         –bonus, health care, 93-031
         –enrollment in Part D, 02-029, 02-030, 02-031, 02-033, CA-076, CA-077, CA-078, CA-079, 07-0021
         –notification of obligation to enroll in Part A & B, 84-448, 84-491, 84-516, 84-679
         –spouse fails to enroll Medicare Part B, 84-637, 02-026
         –benefits only to the extent benefits are not provided for under Medicare, 11-0149
         –coverage of inpatient Medicare deductible, 11-0149
    · Non-duplication, 78-078, 81-411, 81-462, 81-496, 84-128, 88-063, 88-141, 11-0149
         —copayment for spouse with coverage from employer, 98-017
         –-individual insurance policy,88-369
         –Medicare,CA-031
         –spouse’s employer offers coverage, 88-132, 88-496, CA-074
    · Notice of coverage termination,84-440, 84-606, 88-674, CA-047, 16-0004 
    · Preferred Provider List (PPL), 93-035, CA-062 
    · Promulgation of rules,81-155, 81-593, 84-042, 84-196
         –alcoholism and drug rehabilitation program, 88-847 
         –claims reimbursement procedures,78-132, 88-440
         –drug utilization,88-411, 88-414, 88-571
         –employment status questionnaire, 88-113, CA-047
         –enrollment Medicare Part D, 02-029, 02-030, 02-031, CA-076, CA-077, CA-078, CA-079, 07-0021
         –formulary drug program with surcharge , 98-013, 98-014, 02-002 CA-056, CA-072
         –generic vs. brand name drugs, 88-403, 93-079, CA-072
         –hold harmless procedures, 84-264, 84-484, 88-076
         –mail order, 88-613, 93-029, CA-066, 02-001, 02-003
         –prescription drug reimbursement procedures, 84-042, 88-322, 88-403, 88-411, 88-414, 88-571, 88-613
         –time limit on claims submission, 78-337, 81-697, 81-710, 88-645, 11-0027
    · Subrogation,84-252, 84-565, 88-141, 88-369
    –auto insurance, 93-104, 98-049
    –cases covered by workers’ compensation laws, 88-055, 88-525, 88-678
    · Substandard health coverage plan, 81-556, 81-645, 84-030, 84-034, 84-058, 84-125, 84-147, 84-205, 84-215, 84-238, 84-290, 84-325, 84-412, 84-547, 84-632, 88-278, 88-326, 88-623, 88-625, 88-832, 93-035