Important Employee Notifications
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that addresses the privacy and security of certain individually
identifiable health information, called protected health information (or PHI). You have certain rights with respect to your PHI, including a right to see or get
a copy of your health and claims records and other health information maintained by a health plan or carrier. For a copy of the Notice of Privacy
Practices, describing how your PHI may be used and disclosed and how you get access to the information, contact Human Resources.
Women’s Health and Cancer Rights Act Enrollment Notice
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Woman’s Health and Cance r Rights Act of 1998
(WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending
physician and the patient, for:
1. All stages of reconstruction of the breast on which mastectomy was performed.
2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses.
3. Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this
plan.
Patient Protection Notice
Your carrier generally may require the designation of a primary care provider. You have the right to designate any primary care provider who
participates in your network and who is available to accept you or your family members. Until you make this designation, your carrier may designate
one for you.
For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from your carrier or from any other
person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in your
network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures,
including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals.
HIPAA Special Enrollment Notice
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan
coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if
the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or
your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your
dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
Premium Assistance Under Medicaid and t he Children’s Health Insurance Program (CH IP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium
assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children ar en’t eligible for
Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the
Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to
find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of
these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you
qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employerplan, your employer
must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportu nity, and you must request
coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the
Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272 ).
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