Annual Notices
 

ANNUAL NOTICES

  • Women’s Health and Cancer Rights Act 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 the following:

 

  • 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
  • Treatment of physical complications of the mastectomy, including lymphedemas

 

The Montrose County School District benefit plan provides coverage for mastectomies and the related procedures listed above, subject to the deductible and coinsurance applicable to other medical and surgical benefits provided under this plan.

 

  • Medicaid and the Children’s Health Insurance Program (CHIP)

     

    If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage.  These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. 

     

    If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can 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, you can 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, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.  

     

    Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan.  This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.  

     

    You may be eligible for assistance paying your employer health plan premiums.  You should contact your State for further information on eligibility –

     

     

    COLORADO – Medicaid and CHIP

     

    Medicaid Website: http://www.colorado.gov/

     

    Medicaid Phone: 1-800-866-3513

     

    CHIP Website: http:// www.CHPplus.org

     

    CHIP Phone: 303-866-3243

     

     

     

    To see more States that have a premium assistance program, or for more information on special enrollment rights, you can contact either:

     

    U.S. Department of Labor                                                                 U.S. Department of Health and Human Services 

    Employee Benefits Security Administration                                  Centers for Medicare & Medicaid Services

    www.dol.gov/ebsa                                                                               www.cms.hhs.gov                                           

    1-866-444-EBSA (3272)                                                                    1-877-267-2323, Ext. 61565 

     

     

  • Newborns’ and Mothers’ Health Protection Act Notice

     

    This notice is required by the Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA).  Group health plans 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 the mother’s or newborn’s attending physician, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable).  In any case, the plan may not, under federal law, require that a physician obtain authorization from the plan for prescribing a length of stay not in excess of 48 hours (or 96 hours).

  • Special Enrollment Rights

     

    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 later 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).

     

    Loss of eligibility includes, but is not limited to:

    · Loss of eligibility for coverage as a result of ceasing to meet the plan’s eligibility requirements (i.e., legal separation, divorce, cessation of dependent status, death of an employee, termination of employment, reduction in the number of hours of employment);

    · Loss of HMO coverage because the person no longer resides or works in the HMO service area and no other coverage option is available through the HMO plan sponsor;

    · Elimination of the coverage option a person was enrolled in, and another option is not offered in its place;

    · Reaching the plan’s lifetime benefit maximum on all benefits, if the person is covered under a separate plan or a single plan with multiple options and the other option has a higher lifetime maximum, or the benefits paid under the first option were not integrated with the second option;

    · Failing to return from an FMLA leave of absence; and

    · Loss of coverage under Medicaid or the Children’s Health Insurance Program (CHIP).

     

    Unless the event giving rise to your special enrollment right is a loss of coverage under Medicaid or CHIP, you must request enrollment within 30 days after your, or your dependents’, other coverage ends (or after the employer that sponsors that coverage stops contributing toward the coverage).

     

    If the event giving rise to your special enrollment right is a loss of coverage under Medicaid or CHIP, you may request enrollment under this plan within 60 days of the date you or your dependent(s) lose such coverage under Medicaid or CHIP.  Similarly, if you or your dependent(s) become eligible for a state-granted premium subsidy toward this plan, you may request enrollment under this plan within 60 days after the date Medicaid or CHIP determine that you or your dependent(s) qualify for the subsidy.

     

    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.

     

  • Reminder of Availability of HIPAA Privacy Notice

 

The plan listed above maintains a privacy policy pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  Earlier, you should have received a copy of a privacy notice summarizing the plan’s privacy policy.  If you would like another copy of the privacy notice, you may contact Human Resources.