Summary Plan Descriptions (SPD’s)
Summary Plan Descriptions (SPD’s) are summary descriptions of each of the respective benefit plans. To learn more, download the Summary Plan Descriptions below. See link on right hand side under "Dow Benefits" to access the HMO/Insured Wrapper SPD.
- Retiree MAP Plus & Catastrophic Medical Plan (594KB PDF)
| Forms | |
| Aetna Rx Mail Order Form (169KB PDF) | If you participate in the MAP Plus Plan or the Catastrophic Medical Plan, this is your mail order drug enrollment form. |
| Aetna Prescription Drug Claim Form (1888KB 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 (40KB PDF) | Dow’s Medical Care Program has a requirement, called the Working or Retired Spouse/Domestic Partner Rule, that Spouses/Domestic Partners eligible for another employer’s subsidized medical plan must enroll in that plan in order to be covered by the Dow Plan. To document compliance with this rule, the Insurance Information Form must be completed each year for your Pre-Medicare Eligible Spouse/Domestic Partner if you are covering him or her in the MAP Plus or the Catastrophic Medical Plan. |
| Important Notice of Creditable Coverage (72KB PDF) | This notice has information about prescription drug coverage for the calendar year under the medical programs sponsored by The Dow Chemical Company and new Medicare prescription drug coverage offered by the government available January 1, 2006 for people with Medicare. |
| Important Notice of Non-Creditable Coverage (28KB PDF) | This notice has information about prescription drug coverage under the Catastrophic Medical Plan and new prescription drug coverage available January 1, 2006, for people with Medicare. |
Medical Premium Charts
To help you make an informed choice, we have provided a series of charts. The charts outline the costs, coverages and benefit levels for the MAP Plus and the new Catastrophic Medical Plan. Download a Medical Premium chart:
- MAP Plus Plan (152KB PDF)
- Catastrophic Medical Plan (88KB PDF)
Medical Support Schedule and Transitions Credits
DAS Retirees who do not have Full Service need to use the Support Schedule to calculate their monthly medical premium. To help those employees who are closer to Retirement, as well as current DAS Retirees, DAS put in place an additional benefit to help transition participants to the new Retiree Medical premium cap. The Retiree Medical DAS Transition Benefit is known as "transition credits." For more information about "transition credits" and the Support Schedule with the applicable worksheets, download this helpful booklet.
- Calculating Monthly Premiums (208KB PDF)
| Who to Contact | |
| Retiree Service Center |
Toll Free: (800) 344-0661 toll free Phone: (989) 636-0977 |
| Aetna Member Services |
Toll Free: (800) 736-9369 (7DOWDOW) Phone: (610) 336-1000 outside the continental U.S Web site: Aetna |
