ERISA NOTICES
provides “medical care” to employees, former employees, or their families.
• 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. Therefore, the following deductibles and coinsurance apply:
“Medical care” means amounts paid for the diagnosis, cure, mitigation, treatment or prevention of a disease; for the purpose of affecting any structure or function of the body; transportation primarily for or essential to such care or services; or for insurance covering such care or services. As used in this booklet, the term “group health plan” refers to that term as defined in section 607(1) of ERISA and means generally any welfare plan established or maintained by an Employer or employee organization (or both) that provides medical care to employees or their dependents directly or through insurance, reimbursement, or otherwise. ERISA does not generally apply to plans maintained by: Federal, State or local governments; churches; and Employers solely for purposes of complying with applicable workers compensation or disability laws. However, provisions of the Child Support Performance and Incentive Act (CSPIA) of 1998 require church plans to comply with QMCSOs and National Medical Support Notices, and State and local government plans to comply with National Medical Support Notices.
In-Network
COPAY
HSA 1600 HSA 3000
Deductible Individual
Hughston|In-Network
$500 | $1,000 $1,000 | $2,000
$1,600 $3,200
$3,000 $6,000
Family
Coinsurance
20%
20%
0%
If you would like more information on WHCRA benefits, call your plan administrator at 706-494-3447.
WOMEN’S HEALTH AND CANCER RIGHTS ACT ANNUAL NOTICE
Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications
[ERISA §§ 4(b), 609(a), and 607(1), Internal Revenue Code § 213(d), CSPIA § 401(f)].
resulting from a mastectomy, including lymphedema? Call your Plan Administrator for more information.
QMSO Procedures Ordinarily, an Employer may receive a Notice when a child support enforcement agency initially enforces an employee’s medical support obligation, or when an employee with a previously established medical support obligation is newly hired. Part A, Notice to Withhold for Health Care Coverage (which includes an Employer Response), and • Part B, Medical Support Notice to Plan Administrator (which includes a Plan Administrator Response). If the employee named in the Notice is not an employee of the Employer, if the Employer does not maintain or contribute to a plan that provides dependent coverage, or if the named employee is among a class of employees (e.g. part-time or non-union) not eligible for enrollment in a plan that provides dependent coverage, the Employer must check the appropriate box on the Employer Response and return it to the issuing agency within 20 business days after the date of the Notice (or sooner if reasonable). Otherwise, the Employer must transfer Part B of the Notice to the group health plan (or plans) for which the child may be eligible for enrollment not later than 20 business days after the date of the Notice. The Notice is comprised of: •
QUALIFIED MEDICAL SUPPORT ORDER (QMSO) PROCEDURE & OBLIGATIONS
A 1993 amendment to the Employee Retirement Income Security Act (ERISA) requires employment-based group health plans to extend health care coverage to the children of a parent-employee who is divorced, separated, or never married when ordered to do so by state authorities. Generally, a state court or agency may require an ERISA covered health plan to provide health benefits coverage to children by issuing a medical child support order. The group health plan must determine whether the medical child support order is “qualified . ” Such an order is referred to as a Qualified Medical Child Support Order (QMCSO). In addition, a State child support enforcement agency may obtain group health coverage for a child by issuing a National Medical Support Notice that the group health plan determines to be qualified. QMSOs Coverage Requirements The QMCSO provisions apply to “group health plans” subject to the Employee Retirement Income Security Act of 1974, as amended (ERISA). For this purpose a “group health plan” generally is a plan that both:
For these purposes, the “date of the Notice” means the date that is indicated as such on the Notice.
If the Employer offers a number of different types of benefits (e.g., dental, prescription) through separate plans, and the issuing agency has not specified which or all are covered by the Notice, the Employer
• Is sponsored by an Employer or employee organization (or both) and
IMPORTANT NOTICE: This document contains general compliance information only and does not constitute legal advice. For advice specific to your situation, please consult your attorney or tax advisor.
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