Medical - Union Carbide

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 MAP Plus, Catastrophic Medical Plan and the Medicare Supplement Plan (MSP).

MAP Plus Plan (62KB PDF)
Catastrophic Medical Plan (85KB PDF)
Medicare Supplement Plan (MSP) (95KB PDF)
UCC 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 costs, coverages and benefit levels for a specific plan.

Download a plan:

UCC Retiree Medicare Supplement Plan (MSP) (52KB PDF)
UCC Retiree Catastrophic Medical Plan (132KB PDF)
UCC Retiree MAP Plus Plan (76KB PDF)

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

Calculating Premiums (76KB 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)
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:

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.

2011 HMO "Wrapper" (obtain HMO publication from the applicable HMO)

2012 HMO "Wrapper" (obtain HMO publication from the applicable HMO)

Forms
Aetna Rx Mail Order Form (172KB PDF)	If you participate in the MAP Plus Plan, Medicare Supplement Plan or the Catastrophic Medical Plan this is your downloadable 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.