Welfare Summary Plan Description

6.2 ADMINISTRATION OF THE UTILIZATION MANAGEMENT PROGRAMS

The Plan's utilization management program is administered by a Utilization Management Organization. The health care professionals at the Utilization Management Organization focus their review on the necessity and appropriateness of Hospital stays and the necessity, appropriateness and cost-effectiveness of proposed medical or surgical services.

The Utilization Management Organization determines if a course of care or treatment is Medically Necessary.

The Utilization Management Organization certifies the Medical Necessity of proposed treatment.

The Utilization Management Organization does not guarantee that a Participant is eligible for Plan benefits when services are received. Call the Trust Customer Service Office for questions regarding eligibility.