MISSOURI STATE UNIVERSITY · [email protected] (email) Delaware Delaware Department of...
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Grandfather Status under the Affordable Care Act The Employer is acng under the belief that it has a “grandfathered health plan” under the Paent Protecon and Affordable Care Act (the Affordable Care Act). As permied by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your Plan may not include certain consumer protec- ons of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of prevenve health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protecons in the Affordable Care Act, for example, the eliminaon of lifeme limits on benefits. Quesons regarding which protecons apply and which protecons do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the department listed at the boom of this noce. You may also contact the Employee Benefits Security Administraon, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protecons do and do not apply to grandfathered health plans. Women’s Health and Cancer Rights Act of 1998 As required by the Women’s Health and Cancer Rights act of 1998, benefits under the Policy are provided for mastectomy, including reconstruc- on and surgery to achieve symmetry between the breast, prostheses, and complicaons resulng from a mastectomy (including lymphende- ma). If you are receiving benefits in connecon with a mastectomy, benefits are also provided for the following covered health services, as you determine appropriate with your aending Physician: 1) All stages of reconstrucon of the breast on which the mastectomy was performed ; 2) Surgery and reconstrucon of the other breast to produce a symmetrical appearance; and 3) Prostheses and treatment of physical complica- ons of the mastectomy, including lymphendema. The amount you must pay for such covered health services (including copayments and any annual deducble) are the same as are required for any other covered health service. Limitaons on benefits are the same as for any other covered health service. Statement of Rights Under the Newborns’ and Mothers’ Health Protecon Act Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length stay in connecon with childbirth for the mother or newborn child less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean sec- on. However, federal law generally does not prohibit the mother’s or newborn’s aending provider, aſter consulng 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 authorizaon from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Connuaon of Benefits (COBRA) Upon terminaon of employment for reasons other than gross misconduct, connuaon of an employee’s medical, dental and vision coverage – and/or any insured dependent’s coverage - is available for up to 18 months under COBRA (Consolidated Omnibus Budget Reconciliaon Act), with the employee assuming all premium costs. If the employee is disabled, COBRA eligibility is increased to 29 months. The terminang em- ployee will receive personalized informaon concerning COBRA connuaon procedures. Connuaon of coverage is also available for “qualified beneficiaries” up to 36 months when one of the following qualifying events occurs: Death of a covered employee; Divorce or legal separaon; Employee becomes eligible for Medicare; or Dependent child reaches maximum age allowed under group plan Please note: It is the responsibility of you, the employee, or qualified beneficiary to nofy your HR Department of qualifying events, su ch as divorce, legal separaon or dependent child reaching the maximum allowable age to remain on your benefit plans so that COBRA noficaon can be sent. Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Policy The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) imposes upon this Plan and certain other enes various responsibili- es to ensure that protected health informaon (PHI) pertaining to parcipants remains confidenal, subject to limited excepons in which PHI may be disclosed. This noce is available in the health care plan booklet or a full copy of the policy may be obtained by contacng the Office of Human Resources at (417) 836-6616. You may also view the Privacy Noce online at: hp://privacy.missouristate.edu/hipaa/EmployeeBenefits.htm 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 pro- grams that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employ- er-sponsored health coverage, but need assistance in paying their health premiums. If you or your children aren’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 Insu- rance Marketplace. For more informaon, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP, 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 en- rolled 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, you and the qualified dependent are eligible for a Special Enrollment opportunity under this Plan as long as you request coverage within 60 days of being determined eligible for premium assistance. Proper documentaon of qualifying for the subsidy must be provided along with the enrollment form if the applicaon is to be accepted. Legal Notices MISSOURI STATE UNIVERSITY For more information about any of these notices, contact: Paula Huey (417-836-4657), Denise Lofton (417-836-5892), Michel Bampoe (417-836-4781) or Julie Dubinsky (417-836-4571).
Transcript of MISSOURI STATE UNIVERSITY · [email protected] (email) Delaware Delaware Department of...
Grandfather Status under the Affordable Care Act
The Employer is acting under the belief that it has a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your Plan may not include certain consumer protec-tions of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the department listed at the bottom of this notice. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.
Women’s Health and Cancer Rights Act of 1998 As required by the Women’s Health and Cancer Rights act of 1998, benefits under the Policy are provided for mastectomy, including reconstruc-tion and surgery to achieve symmetry between the breast, prostheses, and complications resulting from a mastectomy (including lymphende-ma). If you are receiving benefits in connection with a mastectomy, benefits are also provided for the following covered health services, as you determine appropriate with your attending Physician: 1) All stages of reconstruction of the breast on which the mastectomy was performed ; 2) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3) Prostheses and treatment of physical complica-tions of the mastectomy, including lymphendema.
The amount you must pay for such covered health services (including copayments and any annual deductible) are the same as are required for any other covered health service. Limitations on benefits are the same as for any other covered health service.
Statement of Rights Under the Newborns’ and Mothers’ Health Protection Act Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length stay in connection with childbirth for the mother or newborn child less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean sec-tion. However, federal law generally does not prohibit the mother’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 insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Continuation of Benefits (COBRA) Upon termination of employment for reasons other than gross misconduct, continuation of an employee’s medical, dental and vision coverage – and/or any insured dependent’s coverage - is available for up to 18 months under COBRA (Consolidated Omnibus Budget Reconciliation Act), with the employee assuming all premium costs. If the employee is disabled, COBRA eligibility is increased to 29 months. The terminating em-ployee will receive personalized information concerning COBRA continuation procedures. Continuation of coverage is also available for “qualified beneficiaries” up to 36 months when one of the following qualifying events occurs: Death of a covered employee; Divorce or legal separation; Employee becomes eligible for Medicare; or Dependent child reaches maximum age allowed under group plan
Please note: It is the responsibility of you, the employee, or qualified beneficiary to notify your HR Department of qualifying events, su ch as divorce, legal separation or dependent child reaching the maximum allowable age to remain on your benefit plans so that COBRA notification can be sent.
Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Policy The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) imposes upon this Plan and certain other entities various responsibili-ties to ensure that protected health information (PHI) pertaining to participants remains confidential, subject to limited exceptions in which PHI may be disclosed. This notice is available in the health care plan booklet or a full copy of the policy may be obtained by contacting the Office of Human Resources at (417) 836-6616. You may also view the Privacy Notice online at: http://privacy.missouristate.edu/hipaa/EmployeeBenefits.htm
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 pro-grams that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employ-er-sponsored health coverage, but need assistance in paying their health premiums. If you or your children aren’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 Insu-rance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP, 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 en-rolled 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, you and the qualified dependent are eligible for a Special Enrollment opportunity under this Plan as long as you request coverage within 60 days of being determined eligible for premium assistance. Proper documentation of qualifying for the subsidy must be provided along with the enrollment form if the application is to be accepted.
Legal Notices
MISSOURI STATE UNIVERSITY
For more information about any of these notices, contact: Paula Huey (417-836-4657), Denise Lofton (417-836-5892), Michel Bampoe (417-836-4781) or Julie Dubinsky (417-836-4571).
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Appendix to Technical Release 2016
States with Consumer Assistance Programs under PHS Act Section 2793
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you live in one of the following states, you may be eligible for assistance paying your employer health
plan premiums. The following list of states is current as of March 27, 2016.
Contact your State for more information on eligibility –
State Contact Information Alabama No program
Alaska No program
American Samoa No Program
Arizona No program
Arkansas Arkansas Insurance Department, Consumer Services Division 1200 West Third St., Little Rock, AR 72201 (800) 852-5494 http://insurance.arkansas.gov/csd.htm (website) [email protected] (email)
California California Consumer Assistance Program Operated by the California Department of Managed Health Care and Department of Insurance 980 9th St, Suite #500, Sacramento, CA 95814 (888) 466-2219 http://www.healthhelp.ca.gov/ (website)
Colorado No program
Commonwealth of Northern Mariana Islands
No Program
Connecticut Connecticut Office of the Healthcare Advocate P.O. Box 1543, Hartford, CT 06144 (866) 466-4446 http://www.ct.gov/oha/site/default.asp (website) [email protected] (email)
Delaware Delaware Department of Insurance 841 Silver Lake Blvd, Dover, DE 19904 (800) 282-8611 http://www.delawareinsurance.gov (website) [email protected] (email)
District of Columbia DC Office of the Health Care Ombudsman and Bill of Rights One Judiciary Square 441 4th Street, NW, 900 South, Washington, DC 20001 (877) 685-6391 http://www.healthcareombudsman.dc.gov (website) [email protected] (email)
Florida No Program
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State Contact Information Georgia Georgia Office of Insurance and Safety Fire Commissioner
Consumer Services Division 2 Martin Luther King, Jr. Drive, West Tower, Suite 716 Atlanta, Georgia 30334 (800) 656-2298 http://www.oci.ga.gov/ConsumerService/Home.aspx (website)
Guam Guam Department of Revenue and Taxation 1240 Army Drive, Barrigada, Guam 96921 (671) 635-1846
Hawaii No program
Idaho No program
Illinois Illinois Department of Insurance 320 W. Washington St, 4th Floor, Springfield, IL 62767 (866) 445-5364 http://www.insurance.illinois.gov (website) [email protected] (email)
Indiana No program
Iowa No program
Kansas Kansas Insurance Department Consumer Assistance Division 420 SW 9th Street, Topeka, KS 66612-1678 (800) 432-2484 (in state) (785) 296-3071 (all others) http://www.ksinsurance.org (website) [email protected] (email)
Kentucky Kentucky Department of Insurance, Consumer Protection Division P.O. Box 517, Frankfort, KY 40602-0517 (800) 595-6053 http://insurance.ky.gov (website) [email protected] (email)
Louisiana No program
Maine Consumers for Affordable Health Care 12 Church Street, PO Box 2490, Augusta, ME 04338-2490 (800) 965-7476 http://www.mainecahc.org (website) [email protected] (email)
Maryland Maryland Office of the Attorney General Health Education and Advocacy Unit 200 St. Paul Place, 16th Floor, Baltimore, MD 21202 (877) 261-8807 https://www.oag.state.md.us/Consumer/HEAU.htm (website) [email protected] (email)
Massachusetts Health Care For All One Federal Street, Boston, MA 02110 (800) 272-4232 http://www.massconsumerassistance.org (email)
Michigan Michigan Health Insurance Consumer Assistance Program (HICAP) Michigan Department of Insurance and Financial Services (DIFS) PO Box 30220, Lansing, MI 48909-7720 (877) 999-6442 http://www.michigan.gov/difs (website) [email protected] (email)
Minnesota No program
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State Contact Information Mississippi Health Help Mississippi
800 North President St, Jackson, MS 39202 (877) 314-3843 http://www.healthhelpms.org (website) [email protected] (email)
Missouri Missouri Department of Insurance Truman State Office Building, Room 530 P.O. Box 690, Jefferson City, MO 65102 (800) 726-7390 http://insurance.mo.gov/consumers/ (website) [email protected] (email)
Montana Office of the Montana State Auditor Commissioner of Securities and Insurance 840 Helena Ave, Helena, MT 59601 (800) 332-6148 (in-state only) http://www.montanahealthanswers.com (website)
Nebraska No program
Nevada Office of Consumer Health Assistance Governor’s Consumer Health Advocate 555 East Washington Ave #4800, Las Vegas, NV 89101 (702) 486-3587 (888) 333-1597 http://www.dhhs.nv.gov (website) [email protected] (email)
New Hampshire New Hampshire Department of Insurance 21 South Fruit Street, Suite 14, Concord, NH 03301 (800) 852-3416 http://www.nh.gov/insurance (website) [email protected] (email)
New Jersey New Jersey Department of Banking and Insurance 20 West State Street, PO Box 325, Trenton, NJ 08625 (800) 446-7467 (609) 292-7272 http://www.state.nj.us/dobi/consumer.htm (website) [email protected] (email)
New Mexico New Mexico Public Regulation Commission
Consumer Relations Division 1120 Paseo De Peralta, Santa Fe, NM 87504 (855) 857-0972 or (888) 427-5772 (505) 476-0326 (fax) http://nmprc.state.nm.us/consumer-relations/index.html (website) [email protected] (email)
New York Community Service Society of New York Community Health Advocates 633 Third Avenue, 10th floor, New York, NY 10017 (888) 614-5400 http://www.communityhealthadvocates.org/ (website) [email protected] (email)
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State Contact Information North Carolina North Carolina Department of Insurance
Health Insurance Smart NC 430 N. Salisbury Street, Suite 1018, Raleigh, NC 27603 (855) 885-408-1212 http://www.ncdoi.com/Smart/ (website) Eastern Regional Office: North Carolina Department of Insurance Health Insurance Smart NC 1316 Unit A Commerce Drive New Bern, NC 28562 Western Regional Office: North Carolina Department of Insurance Health Insurance Smart NC 537 College Street Asheville, NC 28801
North Dakota No program
Ohio No program
Oklahoma Oklahoma Insurance Department Five Corporate Plaza 3625 Northwest 56th Street, Suite 100, Oklahoma City, OK 73112-4511 (800) 522-0071 (in-state only) (405) 521-2828 https://www.ok.gov/oid/Consumers/Consumer_Assistance/ (website)
Oregon Oregon Health Connect 1435 NE 81st Ave. Suite 500, Portland, OR 97213-6759 (866) 698-6155 http://211info.org/health/ (website) [email protected] (email)
Pennsylvania Pennsylvania Insurance Department 1326 Strawberry Square, Harrisburg, PA 17120 (877) 881-6388 http://www.insurance.pa.gov (website)
Puerto Rico Puerto Rico Oficina de la Procuradora del Paciente Calle Recinto Sur #303, San Juan, PR 00910 (787) 979-0909 http://www.pr.gov/ (website) [email protected] (email)
Rhode Island Rhode Island Consumer Assistance Program Rhode Island Parent Information Network, Inc. 1210 Pontiac Avenue, Cranston, RI 02920 (855) 747-3224 http://www.rireach.org/ (website) [email protected] (email)
South Carolina South Carolina Department of Insurance Consumer and Individual Licensing Services P.O. Box 100105, Columbia, SC 29202 (803) 737-6180 http://www.doi.sc.gov/638/Health-Insurance (website) [email protected] (email)
South Dakota No program
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State Contact Information Tennessee Tennessee Department of Commerce & Insurance
500 James Robertson Parkway, Davy Crockett Tower, 4th floor Nashville, TN 37243-0565 (615) 741-2241 http://www.tn.gov/commerce/section/consumer-services (website)
Texas Texas Consumer Health Assistance Program Texas Department of Insurance Mail Code 111-1A, 333 Guadalupe, P.O. Box 149091, Austin, TX 78714-9091 (800) 252-3439 http://www.texashealthoptions.com (website) [email protected] (email)
Utah No program
Vermont Vermont Legal Aid 264 North Winooski Ave., Burlington, VT 05402 (800) 889-2047 http://www.vtlegalaid.org (website)
Virginia Virginia State Corporation Commission Life & Health Division, Bureau of Insurance P.O. Box 1157, Richmond, VA 23218 (804) 371-9691 http://www.scc.virginia.gov/boi/cons/index.aspx (website) [email protected] (email)
Virgin Islands U.S. Virgin Islands Division of Banking and Insurance 1131 King Street, Suite 101, Christiansted, St. Croix, VI 00820 (340) 773-6459 http://ltg.gov.vi (website)
Washington Washington Consumer Assistance Program 5000 Capitol Blvd, Tumwater, WA 98501 (800) 562-6900 https://www.insurance.wa.gov/ (website) [email protected] (email)
West Virginia West Virginia Offices of the Insurance Commissioner Consumer Service Division P.O. Box 50540, Charleston, WV 25305-0540 (888) 879-9842 http://www.wvinsurance.gov/ConsumerServices/ConsumerServices.aspx (website)
Wisconsin No program
Wyoming No program
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To see if any other states have added a premium assistance program since the publication of this list, or for more information on special enrollment rights, 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, Menu Option 4, Ext. 61565
