IMPORTANT NOTICES FROM OUR COMPANY REGARDING THE PLAN The following notices provide important information about the group health plan provided by your employer. Please read the attached notices carefully and keep a copy for your records. If you have any questions regarding any of these notices, please contact: Phillips & Jordan Human Resources 10201 Parkside Drive, Suite 300, Knoxville, TN 37922 November 2019 UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT OF 1994 A Subscriber may continue his or her coverage and coverage for his or her Dependents during military leave of absence in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994. When the Subscriber returns to work from a military leave of absence, the Subscriber will be given credit for the time the Subscriber was covered under the Plan prior to the leave. WOMEN’S HEALTH AND CANCER RIGHTS ACT NOTICE If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). If you have had or are going to have a mastectomy, you may be entitled to certain benefits. 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 lymphedema. These benefits will be provided Annual Not ices
subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, contact your Health Insurance issuer. MASTECTOMY NOTICE Patients who undergo a mastectomy and who elect breast reconstruction in connection with the mastectomy are entitled to coverage for: • Reconstructionof thebreast onwhich the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and • Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas Inamannerdeterminedinconsultation with the attending physician and the patient. The coverage may be subject to coinsurance and deductibles consistent with those established for other benefits. Please contact Human Resources for more information. Newborns’ and Mothers’ Health Protection Act requires that group health plans and health insurance issuers who offer childbirth coverage generally may not, 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 themother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Refer to your plan document for specific information about childbirth coverage or contact your plan administrator. NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT
For additional information about NMHPA provisions and how Self- funded non Federal governmental plans may opt-out of the NMHPA requirements, visit http://www.cms. gov/CCIIO/Programs-and-Initiatives/ Other-Insurance-Protections/nmhpa_ factsheet.html. HIPAA NOTICE OF PRIVACY PRACTICES The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires that we maintain the privacy of protected health information, give notice of our legal duties and privacy practices regardinghealth information about you and follow the terms of our notice currently in effect. If not attached to this document, you may request a copy of the current Privacy Practices, explaining how medical information about you may be used and disclosed and how you can get access to this information. As Required by Law. We will disclose Health Information when required to do so by international, federal, state or local law. You have the right to inspect and copy, right to an electronic copy of electronic medical records, right to get notice of a breach, right to amend, right to an accounting of disclosures, right to request restrictions, right to request confidential communications, right to a paper copy of this notice and the right to file a complaint if you believe your privacy rights have been violated. NOTICE OF SPECIAL ENROLLMENT RIGHTS TO NEW ENROLLEES 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,
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