Understanding Your Health Plan Active Employee

Understanding Your Health Plan

Links	Covered Topics
Contact Information	Contacts
Words and Phrases	Glossary
Latitude Health Plan ($500 Deductible)	Master Schedule
$1,000 Deductible Plan	Master Schedule
$1,800 Deductible Plan	Master Schedule
South Dakota State Employee Health Plan Comparison Chart	Plan Comparison Chart
Eligibility and Selecting for Coverage	Selecting Coverage When Coverage Becomes Effective Option Not to Elect Coverage (Opt-Out) Re-Enrolling in the Plan Dual Coverage Family Status Change Special Enrollment Period Late Entrants
Major Medical Benefits	Medical Out-Of-Pocket Limit Obtaining Health Services Medically Necessary Treatment Usual, Customary, and Reasonable Charges (UCR) and/or Maximum Allowable Charges (MAC) Covered Charges Benefit Exclusions Set Payments for CT/MRI/PET Out of Country Coverage Continuous Period of Illness or Injury
Managed Care Program	Pre-authorization Services In-State Pre-authorization Out-of-State Failure to Pre-authorize Hospital and Medical Services Services Requiring Pre-authorization Second Opinions Services Requiring Second Opinions Utilization Review Services Medical Case Management Intensive Medical Case Management
Prescription Drug Plan	Express Scripts, Inc. (ESI) Network Pharmacies (Retail Pharmacies) Copayments Three-Tier Prescription Drug Plan Pharmacy Deductible Per Person Per Plan Year Pharmacy Out-of-Pocket Maximum Special Rules for the $2,000 Deductible Plan (HSA Compatible) Generics Policy Covered Drugs Home Delivery Limits to Benefits Refills and Maintenance Drugs Early Refill Policy Drugs Requiring Pre-authorization Step Therapy Programs Prescription Drug Plan Exclusions Submitting Claims
Latitude Wellness and Prevention	Health Assessment EMPOWERED Health Coaching Health Screenings Asthma Condition Management Program Chronic Pain Condition Management Program Diabetes Condition Management Program Cardiovascular Condition Management Program Cancer Screening Procedures Global Maternity Care Our Healthy Baby Well Child Care Overview of Immunizations and Vaccinations (Chart)
Tobacco User Status	Identification of Tobacco User Status Change to Tobacco User Change to Non-Tobacco User Verification of Tobacco User Flowchart
Claims Payment Process	One-Stop Claim Processing Automatic Claim Process Processing Exceptions Benefit Payments Physical Exams, Autopsy, Second Opinions, and Release of Information Claims Administrator's Right to Investigate Claims Billing and Processing Error Incentive Program
When Coverage Ends and Continuation of Coverage	Approved Leave of Absense Without Pay Retiree Coverage Option to Continue Coverage (COBRA) Electing Continuation Coverage (COBRA) Continuation Coverage Ends Healthcare Certification Conversion of Coverage
Claims Action	Appealing a Denied Claim Legal Action Subrogation
Coordination of Benefits	Benefits Subject to this Provision Definitions Effect on Benefits Medical Coverage for Senior Employees Medical Coverage for Senior Dependent Medical Coverage for Retired Employees Medical Coverage for Certain Employees and Dependents
Plan Administration and Operations	Right to Release and Obtain Necessary Information Facility of Payment Right to Recovery Assignment Plan Modification and Amendment Severability Plan Termination