What Do You Mean It's Not Covered: What Policy Literature Said

The literature Svec received from Garrett was a booklet entitled "Health Care Cost Containment... Employee Involvement" and bears the service mark "Employers Select Risk." The booklet refers to Enterprise and the "Insurance Company" and contains various modifications to Svec's medical insurance coverage under the group policy. The first sentence of the booklet provides as follows: A new package of benefits has been added to your medical coverage. The remainder of the booklet describes an incentive plan for employees to audit medical bills submitted to the insurer and various pre-approval requirements which provide for enhanced reimbursement. The booklet explains that failure to obtain prior approval for specified treatments results in decreased reimbursement levels. Svec knew this booklet did not purport to be a summary of the terms of the master group insurance policy -- like the summaries she had received in connection with her insurance coverage at her previous job. Svec incurred expenses in March 1989, related to her prior treatment for rhinitis and sinusitis and submitted a comprehensive medical claim form for over $5,000 in medical expenses to Enterprise. The claim was dated April 17, 1989.