Administrative Information

Other Plan Information

You will need this information for future reference or if you have any questions about your benefits.

Feature	Maroon Plan	HMO Plans
Plan Name	University of Chicago Maroon Medical Plan; also known as the Maroon Plan	University of Chicago Health Plan HMO Illinois Humana Premier HMO Plan
Employer, Plan Sponsor and Administrator	The University of Chicago 956 East 58th Street Chicago, IL 60637 773-702-9634
Plan Funding and Administration	The Maroon plan is self-insured. The University and employees jointly pay for the coverage. The University has an administrative services contract with a third-party administrator – the claims administrator.	The HMO Plans are fully insured. The University and employees jointly pay for coverage.
Agents for Service of Legal Process	Service of legal process may be made on the plan administrator or the appropriate party listed below:
	The University of Chicago Benefits Office 956 East 58th Street Chicago, IL 60637 773-702-9634	University of Chicago Health Plan 180 N. Harvester Dr. Suite 110 Burr Ridge, IL 60527 HMO Illinois, a Blue Cross HMO 1020 West 31st Street Downers Grove, IL 60515-5622 Humana Inc. 500 W. Main Street Louisville, KY 40202
Claims Administrator (Responsible for processing and paying claims, selecting network providers and, in the case of the HMOs, fully insuring plan benefits.)	Medical Care Blue Cross/Blue Shield of Illinois 300 E. Randolph Street Chicago, IL 60601 Prescription Drugs Caremark 2211 Sanders Road NBT Northbrook, IL 60062	UCHP University of Chicago Health Plan 180 N. Harvester Dr. Suite 110 Burr Ridge, IL 60527 HMO Illinois HMO Illinois, a Blue Cross HMO 1020 West 31st Street Downers Grove, IL 60515-5622 Humana Premier HMO Plan Humana Inc. 500 W. Main Street Louisville, KY 40202
Utilization Review Organization (Responsible for reviewing the required pre-certification procedures.)	Medical Services Advisory Blue Cross/Blue Shield of Illinois 300 E. Randolph Street Chicago, IL 60601 (866) 390-7772
Plan Year	January 1 to December 31 The end of the plan year for fiscal record purposes is December 31.
Employer Identification Number (EIN)	36-2177139
Plan Number	Welfare (medical) – 510
Plan Type	Welfare plan providing insured and self-insured medical benefits.

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.