Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP)

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1 October 16, Open Enrollment - Annual Notices HIPAA Special Enrollment Rights - If you are declining enrollment for medical benefits for yourself or your eligible dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your eligible dependents in the medical benefits provided under this Plan if you or your eligible 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 plan after your or your dependents other coverage ends (or after the employer stops contributing toward the other coverage). 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. If you request a change due to a special enrollment event within the 30 day timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. As of April 1, 2009, the Plan must allow a HIPAA special enrollment for employees and dependents who are eligible but not enrolled if they lose Medicaid or CHIP coverage because they are no longer eligible, or they become eligible for a state s premium assistance program. Employees have 60 days from the date of the Medicaid/CHIP event to request enrollment under the Plan. (Please see the Medicaid and the Children s Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families notice.) If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law. To request special enrollment or obtain more information, contact your local human resources department, and any additional contact information of the appropriate plan representative. Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. 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 Insurance Marketplace. For more information, visit If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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, contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren t already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being

2 determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at or call EBSA (3272). 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 August 10, Contact your State for more information on eligibility ALABAMA Medicaid Phone: ALASKA Medicaid The AK Health Insurance Premium Payment Program Phone: Medicaid Eligibility: x ARKANSAS Medicaid Phone: MyARHIPP ( ) COLORADO Health First Colorado (Colorado s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado Health First Colorado Member Contact Center: / State Relay 711 CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus CHP+ Customer Service: / State Relay 711 KANSAS Medicaid Phone: KENTUCKY Medicaid Phone: LOUISIANA Medicaid Phone: MAINE Medicaid FLORIDA Medicaid Phone: GEORGIA Medicaid - Click on Health Insurance Premium Payment (HIPP) Phone: INDIANA Medicaid Healthy Indiana Plan for low-income adults Phone: All other Medicaid Phone IOWA Medicaid Phone: NEW HAMPSHIRE Medicaid Phone: NEW JERSEY Medicaid and CHIP Medicaid dmahs/clients/medicaid/ Medicaid Phone: CHIP CHIP Phone: NEW YORK Medicaid Phone: NORTH CAROLINA Medicaid

3 Phone: TTY: Maine relay 711 MASSACHUSETTS Medicaid and CHIP alth/ Phone: MINNESOTA Medicaid Phone: MISSOURI Medicaid htm Phone: MONTANA Medicaid PP Phone: NEBRASKA Medicaid Phone: (855) Lincoln: (402) Omaha: (402) NEVADA Medicaid Medicaid Medicaid Phone: Phone: NORTH DAKOTA Medicaid / Phone: OKLAHOMA Medicaid and CHIP Phone: OREGON Medicaid Phone: PENNSYLVANIA Medicaid althinsurancepremiumpaymenthippprogram/index.ht m Phone: RHODE ISLAND Medicaid Phone: SOUTH CAROLINA Medicaid Phone: SOUTH DAKOTA - Medicaid Phone: TEXAS Medicaid Phone: WASHINGTON Medicaid Phone: ext WEST VIRGINIA Medicaid Toll-free phone: MyWVHIPP ( ) UTAH Medicaid and CHIP Medicaid CHIP Phone: VERMONT Medicaid Phone: WISCONSIN Medicaid and CHIP df Phone: WYOMING Medicaid Phone:

4 VIRGINIA Medicaid and CHIP Medicaid cfm Medicaid Phone: CHIP cfm CHIP Phone: To see if any other states have added a premium assistance program since August 10, 2017, 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 EBSA (3272) , Menu Option 4, Ext Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L ) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC or ebsa.opr@dol.gov and reference the OMB Control Number OMB Control Number (expires 12/31/2019) 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 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 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). The Women s Health & 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.

5 These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Therefore, deductibles and coinsurance apply based on the option in which you are enrolled. If you would like more information on WHCRA benefits, call your local Human Resources Department. HIPAA Privacy Notification The privacy rules under the Health Insurance Portability and Accountability Act (HIPAA) requires The Rider University Employee Health Care Plan, Dental Plan, Flexible Spending Account Plan and Employee Assistance Plan (the Plan ) to periodically send a reminder to participants about the availability of the Plan s Privacy Notice and how to obtain that notice. The Privacy Notice explains participants rights and the Plan s legal duties with respect to protected health information (PHI) and how the Plan may use and disclose PHI. You have the right to a paper copy of this Notice. To make such a request, submit a written request to HIPAA Privacy Officer, Office of Human Resources, Rider University, 2083 Lawrence Road, Lawrenceville, NJ 08648, (609) , x7286. You may also obtain a copy of this Notice at the University's website.