LLEEGGAALL NNOOTTI ICCEESS
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 Noticeof PrivacyPractices,describinghow your PHI maybe usedand disclosedand how you get accessto the information,contact Human Resources. Women’s Healthand Cancer RightsAct EnrollmentNotice If you have had or are going to have a mastectomy,you maybe entitledto certainbenefits under the Woman’s Health and Cancer 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 will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this benefitsplan. Ifyou would likemoreinformationon WHCRAbenefits,callyour plan administrator.
Newborns’ and Mothers’ Health Protection Act Disclosure Group health plans and health insuranceissuers generally maynot, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, fromdischarging the motheror her newborn earlierthan 48 hours (or 96 hours as applicable).In any case,plans and issuers maynot, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). 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 familymembers. Untilyou makethis designation,your carrier may designate one for you. For information on how to select a primarycare provider, and for a list of the participating primary care providers, contact the plan carrier. For children,you maydesignate a pediatrician as the primarycare provider. You do not need prior authorization fromyour carrier or from any other person (including a primary care provider) in order to obtain access to obstetricalor gynecological care from a health care professional in your network who specializesin obstetrics or gynecology. The health care professional, however, maybe required to complywith certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the plan carrier. HIPAA Special Enrollment Notice If you are declining enrollment foryourself or your dependents (including your spouse) because of other health insuranceor 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. If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP)or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaidor CHIPcoverage or the determination of eligibilityfor a premiumassistancesubsidy. To request special enrollment orto obtain more information about the plan's special enrollment provisions,contactthe plan administrator.
BENEFITS GUIDE
LEGAL NOTICES I
39
Made with FlippingBook - Online catalogs