How the Maroon Plan Works

When You Must Pre-certify Care

To get the maximum benefit from the plan, you, a family member or your doctor must call the claims administrator:

One business day before a scheduled Hospital admission.

One business day before you are admitted to a Hospital for mental health or substance abuse therapy, Skilled Nursing Facility, coordinated home health care program or partial hospitalization psychiatric treatment program, except in an emergency.

Within two business days after an emergency admission.

If you receive care outside the United States, you are not required to call.

If You Don’t Pre-certify

If you do not call to pre-certify a scheduled Hospital admission or emergency admission, the first $250 of your expenses will not be covered.

Care that is not determined as medically necessary by the claims administrator will not be covered.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.