Caterpillar Employee Assistance Program 12/31/2017 … - caterpillar hewitt benefits resources

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Caterpillar Employee Assistance Program Coverage Period: 01/01/2017 - 12/31/2017
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All coverage tiers | Plan Type: EAP
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
document at www.resources.hewitt.com/cat or by calling 1-877-228-4010.
Important Questions Answers Why this Matters:
What is the overall $0 See the chart starting on page 2 for your costs for services this plan covers.
deductible?
Are there other
deductibles for specific No. You don't have to meet deductibles for specific services, but see the chart starting on page
services? 2 for other costs for services this plan covers.
Is there an out-of-
pocket limit on my No. There's no limit on how much you could pay during a coverage period for your share of
expenses? the cost of covered services.
What is not included in This plan has no out-of-pocket Not applicable because there's no out-of-pocket limit on your expenses.
the out-of-pocket limit.
limit?
Is there an overall Yes, between one and five This plan will pay for covered services only up to this limit during each coverage period,
annual limit on what counseling sessions per year, per even if your own need is greater. You're responsible for all expenses above this limit. This
the plan pays? unique presenting problem. chart starting on page 2 describes specific covered services, such as office visits.
If you use an in-network doctor or other health care provider, this plan will pay some or all
Does this plan use a Yes. For a list of network of the costs of covered services. Be aware, your in-network doctor or hospital may use an
network of providers? providers call 1-866-228-0565. out-of-network provider for some services. Plans use the term in-network, preferred, or
participating for providers in their network. See the chart starting on page 2 for how this
plan pays different kinds of providers.
Do I need a referral to This plan will pay some or all of the costs to see a specialist for covered services but only
see a specialist? Yes. if you have the plan's permission before you see the specialist.
Are there services this Some of the services this plan doesn't cover are listed on page 4. See your policy or plan
plan doesn't cover? Yes. document for additional information about excluded services.
OMB Control Numbers 1545-2229,
1210-0147, and 0938-1146
Corrected on November 21, 2014
Questions: Call 1-877-228-4010 or visit us at www.resources.hewitt.com/cat.
If you aren't clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary 1 of 7
at www.dol.gov/ebsa/healthreform or www.cciio.cms.gov call 1-877-228-4010 to request a copy.
Caterpillar Employee Assistance Program Coverage Period: 01/01/2017 - 12/31/2017
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All coverage tiers | Plan Type: EAP
Copayments are fixed dollar amounts (for example, $15) you pay for covered health care, usually when you receive the service.
Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if
the plan's allowed amount for an overnight hospital stay is $1,000, your coinsurance payment of 20% would be $200. This may change if
you haven't met your deductible.
The amount the plan pays for covered services is based on the allowed amount. If an out-of-network provider charges more than the
allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and
the allowed amount is $1,000, you may have to pay the $500 difference. (This is called balance billing.)
This plan may encourage you to use network providers by charging you lower deductibles, copayments and coinsurance amounts.
Your Cost If Your Cost If
Common
Medical Event Services You May Need You Use a You Use a Limitations & Exceptions
Network Non-network
Provider Provider
Primary care visit to treat an injury or illness N/A
If you visit a health Specialist visit N/A ------------------none-----------------------
care provider's office
or clinic Other practitioner office visit N/A
Preventive care/screening/immunization N/A ------------------none-----------------------
If you have a test Diagnostic test (x-ray, blood work) N/A ------------------none-----------------------
Imaging (CT/PET scans, MRIs) N/A ------------------none-----------------------
If you need drugs to Generic drugs N/A ------------------none-----------------------
treat your illness or
condition Preferred brand drugs N/A ------------------none-----------------------
More information Non-preferred brand drugs N/A ------------------none-----------------------
about prescription
drug coverage is
available at Specialty drugs N/A ------------------none-----------------------
wwwcathealthbenefits.
com.
If you have Facility fee (e.g., ambulatory surgery center) N/A ------------------none-----------------------
outpatient surgery Physician/surgeon fees N/A ------------------none-----------------------
Questions: Call 1-877-228-4010 or visit us at www.resources.hewitt.com/cat.
If you aren't clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary 2 of 7
at www.dol.gov/ebsa/healthreform or www.cciio.cms.gov call 1-877-228-4010 to request a copy.
Caterpillar Employee Assistance Program Coverage Period: 01/01/2017 - 12/31/2017
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All coverage tiers | Plan Type: EAP
Your Cost If Your Cost If
Common Services You May Need You Use a You Use a Limitations & Exceptions
Medical Event Network Non-network
Provider Provider
If you need Emergency room services N/A ------------------none-----------------------
immediate medical Emergency medical transportation N/A ------------------none-----------------------
attention Urgent care N/A ------------------none-----------------------
If you have a Facility fee (e.g., hospital room) N/A ------------------none-----------------------
hospital stay Physician/surgeon fee N/A ------------------none-----------------------
If you have mental Mental/Behavioral health outpatient services N/A ------------------none-----------------------
health, behavioral Mental/Behavioral health inpatient services N/A ------------------none-----------------------
health, or substance Substance use disorder outpatient services N/A ------------------none-----------------------
abuse needs Substance use disorder inpatient services N/A ------------------none-----------------------
If you are pregnant Prenatal and postnatal care N/A ------------------none-----------------------
Delivery and all inpatient services N/A ------------------none-----------------------
Home health care N/A ------------------none-----------------------
If you need help Rehabilitation services N/A ------------------none-----------------------
recovering or have Habilitation services N/A ------------------none-----------------------
other special health Skilled nursing care N/A ------------------none-----------------------
needs Durable medical equipment N/A ------------------none-----------------------
Hospice service N/A ------------------none-----------------------
If your child needs Eye exam N/A ------------------none-----------------------
dental or eye care Glasses N/A ------------------none-----------------------
Dental check-up N/A ------------------none-----------------------
Excluded Services & Other Covered Services:
Services Your Plan Does NOT Cover (This isn't a complete list. Check your policy or plan document for other excluded services.)
Acupuncture Hearing aids Routine foot care
Questions: Call 1-877-228-4010 or visit us at www.resources.hewitt.com/cat.
If you aren't clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary 3 of 7
at www.dol.gov/ebsa/healthreform or www.cciio.cms.gov call 1-877-228-4010 to request a copy.


How does the caterpillar retirement income plan work? The Caterpillar Inc. Retirement Income Plan (the “Plan”) is designed to help you meet your retirement income needs, and it comes at no cost to you. Caterpillar Inc. pays the entire cost of your pension by making contributions to the Caterpillar Inc. Master Retirement Trust (the “Trust”).

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