tomrn Here. For Life. October 6,2011 Important Benefit Information

Transcription

1 Here. For Life. C tomrn October 6,2011 mportant Benefit nformation Annually, the U.S. Department of Labor requires employers to distribute the attached notices to all enrolled participants in the employee health plan. Please review the information and if you have any questions, you may contact Human Resources Benefits Department at or

2 Medicaid and the Children's Health nsurance Program (CHP) Offer Free Or Low-Cost Health Coverage To Children And Families f 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 CHP programs to help people who are eligible for employersponsored health coverage, but need assistance in paying their health premiums. f you or your dependents are already enrolled in Medicaid or CHP and you live in a State listed below, you can contact your State Medicaid or CHP office to find out if premium assistance is available. f you or your dependents are NOT currently enrolled in Medicaid or CHP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHP office or dial KDS NOW or to find out how to apply. f 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 CHP, 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. f 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 January 31, You should contact your State for further information on eligibility - ALABAMA -Medicaid Website: Phone: ALASKA -Medicaid CALFORNA - Medicaid Website: TPLRECAU-cont.aspx ( Phone: COLORADO - Medicaid and CHlP Website: Phone (Outside of Anchorage): Phone (Anchorage): ARZONA - CHP Medicaid Website: Medicaid Phone (n state): Medicaid Phone (Out of state): CHlP Website: CHP Phone: Website: Phone (Outside of Maricopa County): Phone (Maricopa County): ARKANSAS - CHP FLORDA - Medicaid ] Website: ( Website: Phone: Phone: GEORGA - Medicaid MSSOUR - Medicaid

3 Website: Click on Programs, then Medicaid Phone: DAHO - Medicaid and CHP Medicaid Website: Medicaid Phone: CHP Website: CHP Phone: Website: Phone: MONTANA - Medicaid Website: clientindex.shtrn1 Phone: Website: NDANA - Medicaid NEBRASKA - Medicaid Website: Phone: ( Phone: OWA - Medicaid 1 Website: Phone: KANSAS - Medicaid Website: Phone: NEVADA - Medicaid and CHP Medicaid Website: Medicaid Phone: CHP Website: CHP Phone: ( Website: Website: Phone: Phone: LOUSANA -Medicaid Website: Phone: MANE -Medicaid Website: assistance/index.htrnl Phone: MASSACHUSETTS - Medicaid and CHP Medicaid & CHP Website: Medicaid & CHP Phone: MNNESOTA - Medicaid Website: 1 Click on Health Care, then Medical Assistance Phone (Outside of Twin City area): Phone (Twin Ci+q area): NEW YORK - Medicaid NEW JERSEY - Medicaid and CHP Medicaid Website: dmahs/clients/rnedicaid/ Medicaid Phone: CHP Website: CHP Phone: NEW MEXCO - Medicaid and CHP Medicaid Website: Medicaid Phone: CHP Website: htt~:// htrnl Click on nsure New Mexico CHP Phone: TEXAS - Medicaid KENTUCKY - Medicaid NEW HAMPSHRE - Medicaid

4 Website: 1 Phone: Website: NORTH CAROLNA - Medicaid _ Phone: NORTH DAKOTA -Medicaid Website: Phone: UTAH - Medicaid Website: Phone: VERMONT- Medicaid t Website: Phone: OKLAHOMA -Medicaid Website: Phone: Website: Phone: VRGNA - Medicaid and CHP Medicaid Website: Medicaid Phone: CHP Website: CHP Phone: OREGON - Medicaid and CHP WASHNGTON - Medicaid Medicaid & CHP Website: Medicaid & CHP Phone: Website: httpyhrsa.dshs.wa.gov/premiumpymt/apply.shtm Phone: ext PENNSYLVANA - Medicaid Website: ngbusiness/ htm Phone: WEST VRGNA - Medicaid Website: Phone: Website: Phone: Website: Phone: RHODE SLAND - Medicaid SOUTH CAROLNA - Medicaid WSCONSN - Medicaid Website: badgercareplus.org/pubs/p-l0095.htm Phone: WYOMNG - Medicaid Website: Phone: To see if any more States have added a premium assistance program since January 3 1,201 1, 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 EBSA (3272) , Ext

5 Women's Health and Cancer Rights Act mportant Notice The Women's Health and Cancer Rights Act of 1998 requires group health plans to make certain benefits available to participants who have undergone a mastectomy. n particular, a plan must offer mastectomy patients benefits for: All stages of reconstruction of the breast on which the mastectomy was performed 8 Surgery and reconstruction of the other breast to produce a symmetrical appearance Prostheses Treatment of physical complications of the mastectomy, including lymphedema Our plan complies with these requirements. Benefits for these items generally are comparable to those provided under our plan for similar types of medical services and supplies. Of course, the extent to which any of these items is appropriate following mastectomy is a matter to be determined by the patient and her physician. Our plan neither imposes penalties (for example, reducing or limiting reimbursements) nor provides incentives to induce attending providers to provide care inconsistent with these requirements. f you would like more information about WHCRA required coverage, you can contact the Human Resources Benefits Department at our telephone number: (504)

6 mportant Notice from Touro nfirmary About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Touro nfirmary and about your options under Medicare's prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. f you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. nformation about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare's prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Touro lnfirmary has determined that the prescription drug coverage offered by the Touro lnfirmary Employee Health Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare k g Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP)to join a Medicare drug plan. CMS Form CC Updated April 1,201 1 According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is The time required to complete this information collection is estimated to average 8 hours per response initially, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. f you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C , Baltimore, Maryland

7 ' What Happens To Your Current Coverage f You Decide to Join A Medicare Drug Plan? f you decide to join a Medicare drug plan, your current Touro lnfirmary coverage will be affected. f you do decide to join a Medicare drug plan and drop your current Touro lnfirmary coverage, be aware that you and your dependents will not be able to get this coverage back. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You sho~lld also know that if you drop or lose your current coverage with Touro lnfirmary and don't join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. f you go 63 continuous days or longer without creditable prescription drug coverage, your monthly prernium may go up by at least 1 % of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. n addition, you may have to wait until the following October to join. For More nformation About This Notice Or Your Current Prescription Drug Coverage... Contact the person listed below for further information. NOTE: You'll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Touro lnfirmary changes. You also may request a copy of this notice at any time. CMS Form CC Updated April 1,2011 According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is The time required to complete this information collection is estimated to average 8 hours per response initially, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. f you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Ath: PRA Reports Clearance Officer, Mail Stop C , Baltimore, Maryland

8 For More nformation About Your Options Under Medicare Prescription Drug Coverage... More detailed information about Medicare plans that offer prescription drug coverage is in the "Medicare & You" handbook. You'll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit Call your State Health nsurance Assistance Program (see the inside back cover of your copy of the "Medicare & You" handbook for their telephone number) for personalized help Call -800-MEDCARE ( ). TTY users should call f you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Creditable Coverage notice. f you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: September 30,201 1 Name of EntitySender: Contact--Position/Office: Touro nfirmary Human Resources Benefits Department Address: 1401 Foucher Street, New Orleans, LA Phone Number: (504) CMS Form CC Updated April 1,201 1 According to the Papenvork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The validoml3 control number for this information collection is The time required to complete this information collection is estimated? to average 8 hours per response initially, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. f you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C , Baltimore, Maryland

9 Grandfather Status This Touro nfirmary Employee Health Plan believes this program, Touro nfirmary Employee Health Plan is 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 coverage under Touro nfivmary Employee Health Plan may not include certain consumer protections 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 plan administrator at (504) Human Resources Benefits Department. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at or This website has a table summarizing which protections do and do not apply to grandfathered health plans. Notice of Availability Touro nfirmary Employee Health Plan Notice of Privacy Practices THS NOTCE DESCRBES HOW YOU MAY OBTAN A COPY OF THE PLAN'S NOTCE OF PRVACY PRACTCES, WHCH DESCRBES THE WAYS THAT THE PLAN USES AND DSCLOSES YOUR PROTECTED HEALTH NFORMATON. Touro nfirmarv Emplovee Health Plan (the "Plan") provides health benefits to eligible employees of Touro nfirmary (the "Company") and their eligible dependents as described in the summary plan description(s) for the Plan. The Plan creates, receives, uses, maintains and discloses health information about participating employees and dependents in the course of providing these health benefits. The Plan is required by law to provide notice to participants of the Plan's duties and privacy practices with respect to covered individuals' protected health information, and has done so by providing to Plan participants a Notice of Privacy Practices, which describes the ways that the Plan uses and discloses PH. To receive a copy of the Plan's Notice of Privacy Practices you should contact Don JZimmerman, who has been designated as the Plan's contact person for all issues regarding the Plan's privacy practices and covered individuals' privacy rights. You can reach this contact person at: 1401 Foucher St., New Orleans, LA / or by fax (504)