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Benefit Booklet for Eligible Employees of Delhaize America's CDHP Medical Basic Plan For

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Benefit Booklet for Eligible Employees of Delhaize America's CDHP Medical Basic Plan For Benefit Booklet For Eligible Employees of Delhaize America's CDHP Medical Basic Plan for An Independent Licensee of the Blue Cross and Blue Shield Association Blue Options HRA/012460/3EDS/01012012/08272012 BENEFIT BOOKLET This benefit booklet describes the CDHP Medical Basic Plan EMPLOYEE health plan (the PLAN). Blue Cross and Blue Shield of North Carolina provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims. Please read this benefit booklet carefully. The benefit plan described in this booklet is an EMPLOYEE health benefit plan, subject to the Employee Retirement Income Security Act of 1974 (ERISA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). A summary of benefits, conditions, limitations and exclusions is set forth in this benefit booklet for easy reference. In the event of a conflict between this benefit booklet and the terms in the PLAN document, the PLAN document will control. Amendment and/or Termination of the PLAN The PLAN SPONSOR expects this PLAN to be continued indefinitely, but the PLAN SPONSOR reserves the right to terminate the PLAN at any time with respect to its EMPLOYEES by a written instrument signed by an officer of the PLAN SPONSOR. Such termination may be made without the consent of the MEMBERS, or any other persons. The PLAN SPONSOR also reserves the right to amend the PLAN, including reduction or elimination of benefits or COVERED SERVICES. Amendments shall be made only in accordance with the provisions of the PLAN. The PLAN ADMINISTRATOR will provide notice to MEMBERS within sixty days of the adoption of any amendment that results in a material reduction in COVERED SERVICES or benefits. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. TABLE OF CONTENTS GETTING STARTED WITH CDHP MEDICAL BASIC PLAN................................................. 1 AVISO PARA AFILIADOS QUE NO HABLAN INGLES...................................................................................1 USING INFORMATIONAL GRAPHICS............................................................................................................1 WHOM DO I CONTACT?........................................................................................................3 SUMMARY OF BENEFITS......................................................................................................6 HOW CDHP MEDICAL BASIC WORKS.............................................................................. 13 Out-of-Network Benefit Exceptions.................................................................................................................14 CARRY YOUR IDENTIFICATION CARD.......................................................................................................14 THE ROLE OF A PRIMARY CARE (PCP) OR SPECIALIST........................................................................ 15 COVERED SERVICES.......................................................................................................... 16 OFFICE SERVICES........................................................................................................................................16 Office Services Exclusion............................................................................................................................16 PREVENTIVE CARE...................................................................................................................................... 16 Bone Mass Measurement Services.............................................................................................................16 Colorectal Screening....................................................................................................................................17 Gynecological Exam and Cervical Cancer Screening.................................................................................17 Immunizations.............................................................................................................................................. 17 Newborn Hearing Screening....................................................................................................................... 17 Ovarian Cancer Screening.......................................................................................................................... 17 Prostate Screening...................................................................................................................................... 17 Routine Physical Examinations and Screenings.........................................................................................18 Screening Mammograms.............................................................................................................................18 Well-Baby And Well-Child Care.................................................................................................................. 18 DIAGNOSTIC SERVICES.............................................................................................................................. 18 Diagnostic Services Exclusion.....................................................................................................................18 EMERGENCY CARE .................................................................................................................................... 18 What to Do in an Emergency.........................................................................................................................19 URGENT CARE..............................................................................................................................................19 FAMILY PLANNING........................................................................................................................................19 Maternity Care............................................................................................................................................. 19 COMPLICATIONS OF PREGNANCY......................................................................................................... 21 INFERTILITY Services.................................................................................................................................21 Sexual Dysfunction Services....................................................................................................................... 21 Sterilization...................................................................................................................................................21 Family Planning Exclusions.........................................................................................................................21 FACILITY SERVICES.....................................................................................................................................21 OTHER SERVICES........................................................................................................................................ 22 Ambulance Services.................................................................................................................................... 22 Blood............................................................................................................................................................ 22 Clinical Trials............................................................................................................................................... 22 Dental Treatment Covered Under Your Medical Benefit.............................................................................23 Diabetes-Related Services.......................................................................................................................... 24 Durable Medical Equipment........................................................................................................................ 24 Food Supplement........................................................................................................................................ 24 Home Health Care.......................................................................................................................................25 Home Infusion Therapy Services................................................................................................................ 25 Hospice Services......................................................................................................................................... 25 Lymphedema-Related Services...................................................................................................................25 Medical Supplies..........................................................................................................................................26 Orthotic Devices.......................................................................................................................................... 26 Private Duty Nursing....................................................................................................................................26 Prosthetic Appliances.................................................................................................................................. 26 TABLE OF CONTENTS (cont.) SURGICAL BENEFITS..................................................................................................................................
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