Legal Notices
Eligibility
An eligible employee with respect to the programs described in this Guide is any individual who is designated as eligible to participate in and receive benefits under one or more of the component benefit programs described herein. The eligibility and participation requirements may vary depending on the particular component program. You must satisfy the eligibility requirements under a particular component benefit program in order to receive benefits under that program. Certain individuals related to you, such as a spouse or your dependents, may be eligible for coverage under certain component benefit programs. To determine whether you (or your dependents) are eligible to participate in a component benefit program, please read the eligibility information contained in the Plan Document for the applicable component benefit programs.
Notice Regarding Special Enrollment
Loss of Other Coverage (excluding Medicaid or a State Children’s Health Insurance Program)
If you decline enrollment yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, 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). 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).
Loss of coverage under Medicaid or a State Children’s Health Insurance Program
If you decline enrollment yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a State children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ coverage under Medicaid or a state children’s health insurance program (CHIP).
New dependent by marriage, birth, adoption, or placement for adoption
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 new dependents. However, you must request enrollment within 30 days of the marriage, birth, adoption, or placement for adoption. For a new dependent, coverage will be effective the date of birth, adoption or placement for adoption. For marriage, coverage will be effective the first day of the month following the request for enrollment.
Eligibility for Medicaid or a State Children’s Health Insurance Program
If you or your dependents (including your spouse) become eligible for state premium assistance under Medicaid or a State children’s health insurance program (CHIP) with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance.
For more special enrollment information or assistance, contact Human Resources.
Newborns’ and Mothers’ Health Protection Act
Group health plans and health insurance issuers offering group health insurance 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 the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or newborn earlier than 48 hours (or 96 hours, as applicable).
Also, under federal law, group health plans and health insurance issuers may not require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay of up to 48 hours (or 96 hours, as applicable).
Women’s Health and Cancer Rights Act
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). 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 subject to the same deductibles and coinsurance applicable to other benefits. If you have any questions, please speak with Human Resources.
Availability of Summary Health Information
As an employee, the health benefits available to you represent a significant component of your compensation package, which provides important protection for you and your family in the case of illness or injury. Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, this plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in standard format, to help you compare options.