WOMEN’S HEALTH AND CANCER RIGHTS NOTICE
MANN+HUMMEL US, Inc. Employee Health Care Plan is required by law to provide you with the following notice:
The Women’s Health and Cancer Rights Act of 1998 (“WHCRA”) provides certain protections for individuals receiving mastectomy-related benefits. Coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
• All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedemas.
The MANN+HUMMEL US, Inc. Employee Health Care Plan provide(s) medical coverage for mastectomies and the related procedures listed above, subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Therefore, the following deductibles and coinsurance apply:
CDHP
In-Network
Out-of-Network
Individual Deductible
$2,000
$4,000
Family Deductible
$4,000
$8,000
Coinsurance
20%
40%
PPO
In-Network
Out-of-Network
Individual Deductible
$1,000
$2,000
Family Deductible
$2,000
$4,000
Coinsurance
20%
40%
Catastrophic Plan
In-Network
Out-of-Network
Individual Deductible
$6,500
$15,000
Family Deductible
$13,000
$30,000
Coinsurance
30%
50%
If you would like more information on WHCRA benefits, please refer to your Summary Plan Description or contact your Plan Administrator at:
Laurel Gregory Manager, Benefits and Compensation 980-318-2744
GINA Notice The Genetic Information Non-Discrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. Genetic information as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
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