Medical - Dow

Medical Comparison Charts
To help you make an informed choice, we have provided a series of charts. The charts outline the coverages and benefit levels for the Old Plan, New Plan, MAP Plus and the Catastrophic Medical Plan.

Dow Old and New Plan (62KB PDF)
Catastrophic Medical Plan (85KB PDF)
MAP Plus Plan (95KB PDF)
Dow Retiree HMO State Specific Charts & Premiums

Medical Premium Charts
To help you make an informed choice, we have provided a series of charts. The charts outline the premium costs for the Old Plan, New Plan, MAP Plus and the Catastrophic Medical Plan.

Dow Old and New Plan (482KB PDF)
Catastrophic Medical Plan (945KB PDF)
MAP Plus Plan (938KB PDF)

Medical Support Schedule
To help calculate your monthly premium if you are on the Support Schedule, download this helpful booklet.

Calculating Premiums - Dow (176KB PDF)
Calculating Premiums - DAS (223KB PDF)

Summary Plan Descriptions (SPD's)

Please select the summary plan description (SPD) applicable to you:

2011 MAP Plus and Catastrophic Medical Plan
2012 MAP Plus and Catastrophic Medical Plan - (Appendix A will be posted soon)
2011 Old Plan/New Plan
2012 Old Plan/New Plan
International Medical and Dental Plan

The SPD's for the self-funded HMO's are comprised of two parts: 1) SPD Wrapper and 2) Appendix A:

2011 Self-Funded HMO SPD Wrapper(applies to all self-funded HMO's)
2012 Self-Funded HMO SPD Wrapper(applies to all self-funded HMO's)
Appendix A for: Blue Cross Blue Shield of Michigan (for Illinois) Self Funded Plan
Appendix A for: Blue Care Network (Midland/Tri-Cities Michigan) Self-Funded Plan
Appendix A for: CIGNA Self Funded Plan
Appendix A for: Health Partners Minnesota Plan
Appendix A for: Humana Self-Funded Plan

The SPD's for the insured HMO's are comprised of two parts: 1) SPD Wrapper and 2) HMO publication. The SPD wrapper is at the link below. Contact your HMO or Secova (800-7DOWDOW or 800-858-4347 and www.secova.com) to obtain a copy of the HMO publication, which contains coverage details.

Forms
Aetna Mail Order Rx Form (169KB PDF)	If you participate in the Old Plan, New Plan, MAP Plus Plan, or the Catastrophic Medical Plan this is your mail order drug enrollment form.
Aetna Prescription Drug Claim Form (188KB PDF)	When making a claim for prescription drug benefits reimbursement, this form must accompany itemized bills from your pharmacy.
Aetna Medical Claim Form (32KB PDF)	When making a claim for medical benefits reimbursement, this form must accompany itemized bills from your health care provider.
AETNA Spouse/Domestic Partner Insurance Form Link	If you are enrolling your Spouse/Domestic Partner in MAP Plus or the Catastrophic Medical Plan, this form must be completed and sent to Aetna each year.