COUNTY OF KERN IMPORTANT NOTICES EXTRA HELP/TEMPORARY EMPLOYEES ENCLOSED NOTICES: COBRA Cntinuatin Cverage and Initial Ntificatin HIPAA Privacy Plicy and Ntice Medicare and Prescriptin Drug Cverage Ntice Wmen s Health and Cancer Rights Act Lifetime Limits Patient Prtectin Disclsure Ntice Extensin f Dependent Cverage t Age 26 Medicaid and the Children Health Insurance Prgram (CHIP) Health Insurance MarketPlace Cverage Optins and Yur Health Cverage Yur Rights and Obligatins as a pregnant emplyee Ntice A Family Care, Medical Leave and Pregnancy Leave Ntices Ntice B
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Table f Cntents Cunty f Kern Imprtant Ntices COBRA Cntinuatin Cverage Very imprtant Letter... 1 COBRA Initial Ntificatin... 3 HIPAA Privacy Plicy and Ntice... 7 Medicare and Prescriptin Drug Cverage Ntice... 14 Wmen s Health and Cancer Rights Act... 16 Lifetime Limits (Eliminatin)... 16 Patient Prtectin Disclsure Ntice... 17 Extensin f Dependent Cverage t Age 26... 17 Medicaid and the Children s Health Insurance Prgram (CHIP)... 18 Health Insurance MarketPlace Cverage Optins and Yur Health Cverage... 21 Yur Rights and Obligatins as a pregnant emplyee Ntice A... 23 Family Care, Medical Leave and Pregnancy Leave Ntices... 25 Kern Cunty Human Resurces Divisin Health Benefits 1115 Truxtun Ave, 1 st flr Bakersfield, Califrnia 93301 (661) 868-3182 (661) 868-3110 (Fax) Email: healthbenefits@kerncunty.cm
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Kern Cunty HR Cunty Administrative Office 1115 Truxtun Avenue, 1st Flr, Bakersfield, CA 93301 Telephne (661) 868-3182 Fax (661) 868-3110 Ryan J. Alsp Cunty Administrative Officer Devin W. Brwn Chief Human Resurces Officer Very Imprtant Letter COBRA Cntinuatin Cverage On April 7, 1986, a federal law was enacted (Public Law 99-272, title X) requiring that mst emplyers spnsring grup health plans ffer emplyees and their families the pprtunity fr a temprary extensin f health cverage (called cntinuatin cverage) at grup rates in certain instances where cverage under the plan wuld therwise end. This ntice is intended t infrm yu, in a summary fashin, f yur rights and bligatins under the cntinuatin cverage prvisins f the law. (Bth yu and yur cvered dependents shuld take the time t read this ntice carefully.) If yu are an emplyee f the Cunty f Kern cvered by Cunty Health Plans, yu have a right t chse this cntinuatin cverage if yu lse yur grup health cverage because f a reductin in yur hurs f emplyment r the terminatin f yur emplyment (fr reasns ther than grss miscnduct n yur part). If yu are the spuse f an emplyee cvered by the Cunty Health Plans, yu have the right t chse cntinuatin cverage fr yurself if yu lse grup health cverage under the Cunty Health Plans fr any f the fllwing fur reasns: 1. The death f yur spuse; 2. A terminatin f yur spuse s emplyment (fr reasns ther than grss miscnduct) r reductin in yur spuse s hurs f emplyment; 3. Divrce r legal separatin frm yur spuse; 4. Yur spuse becmes eligible fr Medicare. In the case f a dependent child f an emplyee cvered by the Cunty Health Plans, he r she has the right t cntinuatin cverage if grup health cverage under the Cunty Health Plan is lst fr any f the five reasns: 1. The death f a parent; 2. The terminatin f a parent s emplyment (fr reasns ther than miscnduct) r reductin in a parent s hurs f emplyment with the Cunty f Kern 3. Parent s divrce r legal separatin; 4. A parent becmes eligible fr Medicare; 5. The dependent ceases t be a dependent child under the Cunty Health Plans. Under the COBRA law, the emplyee r a family member has the respnsibility t infrm Kern Cunty Human Resurces f a divrce, legal separatin, r a child lsing dependent status under the Cunty Health Plans by submitting prper dcumentatin at the fllwing address: Kern Cunty Human Resurces Divisin - Emplyee Benefits; 1115 Truxtun Avenue, 1 st Flr; Bakersfield, CA 93301. The Cunty f Kern has the respnsibility t ntify the COBRA Administratr f the emplyee s death, terminatin f emplyment r reductin in hurs, r Medicare eligibility. 1
Upn ntificatin, the Cunty f Kern (r their third party administratr) will ntify yu that yu have a right t chse cntinuatin cverage within 60 days f the date cverage wuld terminate. If cntinuatin cverage is chsen, the Cunty f Kern is required t give cverage which is, as f the time cverage is being prvided, identical t the cverage prvided under the plans t similarly situated emplyees r family members. If yu lst grup health cverage because f terminatin f emplyment r reductin in hurs, the COBRA law requires that yu be affrded the pprtunity t maintain cntinuatin cverage fr 18 mnths. If cverage was lst fr ne f the ther qualifying reasns, dependent cntinuatin cverage is ffered fr three (3) years. Hwever, the COBRA law als prvides that yur cntinuatin cverage may be cut shrt fr any f the fllwing fur reasns: 1. The Cunty f Kern n lnger prvides grup health cverage t any f its emplyees; 2. The premium fr yur cntinuatin cverage is nt paid; 3. Yu becme eligible fr Medicare; 4. Yu were divrced frm a cvered emplyee and subsequently remarry and are cvered under yur new spuse s grup health plan. Yu d nt have t shw that yu are insurable t chse cntinuatin cverage. Hwever, under the law, yu will have t pay all r part f the premium f yur cntinuatin cverage. (The new law als prvides that at the end f yur cntinuatin perid, yu be allwed t enrll in an individual health plan, if ne is available). If yu d nt chse cntinuatin cverage, yur grup health insurance will end. 2
Kern Cunty HR Cunty Administrative Office 1115 Truxtun Avenue, 1st Flr, Bakersfield, CA 93301 Telephne (661) 868-3480 Fax (661) 868-3928 Ryan J. Alsp Cunty Administrative Officer Devin W. Brwn Chief Human Resurces Officer TO: RE: ALL COUNTY EMPLOYEES, SPOUSES, AND DEPENDENTS COVERED BY THE COUNTY S HEALTH PLANS ENCLOSED COBRA INITIAL NOTIFICATION Yu and yur dependents are nw, r will sn be, cvered under the Cunty f Kern s grup health insurance plan(s). Under federal Cnslidated Omnibus Recnciliatin Act f 1985, we are required t prvide yu with the enclsed COBRA ntificatin. The enclsed ntice des nt mean yu are lsing yur grup health insurance! This ntice simply utlines cvered participants future ptins and mre imprtantly yur ntificatin bligatins under the federal Cnslidated Omnibus Recnciliatin Act f 1985 (COBRA) law. Shuld yu ever fail t qualify fr Cunty health insurance in the future: Step #1 Step #2 Step #3 Step #4 Please read the ntice carefully. It is imprtant that each individual cvered under the plan read the ntice and be familiar with the infrmatin. If there is a cvered dependent whse legal residence is nt yurs, yu are required t prvide in writing t the benefits department the apprpriate address s a separate ntice can be sent t them as well. Please use the enclsed COBRA Address Ntificatin Frm fr this purpse. Understand Yur COBRA Ntificatin Obligatins! Under the terms f the grup health plan, nly a spuse and eligible dependents, as defined by the grup health insurance plicy, can be cvered under the plan. Therefre, under the rules f the plicy and COBRA, yu r a cvered spuse/dependent are required t infrm the plan administratr f a divrce/legal separatin r if a cvered dependent ceases t be a dependent under the terms f the grup health plan. Please take special nte f the sectin in this ntice that details yur ntificatin bligatins and the apprpriate steps t take when making this ntificatin. Shuld yu fail t fllw the utlined ntificatin prcedures; any cntinuatin cverage rights under COBRA will be lst. Place this ntice in yur recrds fr future reference. Shuld yu have any questins cncerning this ntice r yur ntificatin bligatins, please cntact Kern Cunty Human Resurces Emplyee Benefits at (661) 868-3182. 3
INITIAL COBRA NOTIFICATION VERY IMPORTANT NOTICE It is imprtant that all cvered individuals (emplyee, spuse and dependent children, if able) take the time t read this ntice carefully and be familiar with its cntents. If there is a cvered dependent whse legal residence is nt yurs, please prvide written ntificatin with the COBRA Address Ntificatin Frm t the benefits department s a ntice can be sent t them as well. Under federal law, The Cunty f Kern is required t ffer cvered emplyees and cvered family members the pprtunity fr a temprary extensin f health cverage (called Cntinuatin Cverage ) at grup rates when cverage under the health plan wuld therwise end due t certain qualifying events. This ntice is intended t infrm yu (and yur cvered dependents, if any), in a summary fashin, f yur ptins and bligatins under the cntinuatin cverage prvisins f the COBRA law. Shuld a qualifying event ccur in the future, the plan administratr will send yu additinal infrmatin and the apprpriate electin ntice at that time. Please take special nte, hwever, f yur ntificatin bligatins which are highlighted at the bttm f this page! Qualifying Events fr Cvered Emplyee - If yu are a cvered emplyee, yu may have the right t elect this health plan cntinuatin cverage if yu lse grup health cverage because f a terminatin f yur emplyment (fr reasns ther than grss miscnduct n yur part) r a reductin in yur hurs f emplyment. Qualifying Events fr Cvered Spuse - If yu are a cvered spuse f an emplyee, yu may have the right t elect this health plan cntinuatin cverage fr yurself if yu lse grup health cverage under the Cunty Health Plans because f any f the fllwing reasns: A terminatin f yur spuse s emplyment (fr reasns ther than grss miscnduct) r reductin in yur spuse s hurs f emplyment with the Cunty f Kern.; The death f yur spuse; Divrce r, if applicable, legal separatin frm yur spuse; r Yur spuse becmes entitled t Medicare. Qualifying Events fr Cvered Dependent Children * - If yu are a cvered dependent child f an emplyee, yu may have the right t elect cntinuatin cverage fr yurself if yu lse grup health cverage under the Cunty Health Plans because f any f the fllwing reasns: A terminatin f the emplyee s emplyment (fr reasns ther than grss miscnduct) r reductin in the emplyee s hurs f emplyment with the Cunty f Kern.; The death f the emplyee f the Cunty f Kern; Parent s divrce r, if applicable, legal separatin; The emplyee f the Cunty f Kern becmes entitled t Medicare; r Yu cease t be a dependent child under the terms f the health plan. *Rights similar t thse described abve may apply t cvered retirees, and their cvered spuses, and dependents if the emplyer cmmences a bankruptcy prceeding and these individuals lse cverage within ne year f r ne year after the bankruptcy filing. Imprtant Emplyee, Spuse, and Dependent Ntificatins Required Under the law, the emplyee, spuse, r ther family member has the respnsibility t ntify the Kern Cunty Human Resurces f a divrce, legal separatin, r child lsing dependent status under the Cunty Health Plans. This ntificatin must be made within 60 days frm whichever date is later: the date f the event, r the date n which the health plan cverage wuld be lst under the terms f the insurance cntract because f the event. If there is a divrce, separatin, r lss f dependent status, the emplyee r ther family member must ntify the Cunty f Kern at the fllwing address: Kern Cunty Human Resurces Emplyee Benefits 1115 Truxtun Avenue, 1 st Flr, Bakersfield, CA 93301 4
If this ntificatin is nt cmpleted accrding t the prceeding prcedures and within the required 60-day ntificatin perid, then rights t cntinuatin cverage will be frfeit. Carefully read the dependent eligibility rules cntained in the summary plan descriptin s yu are all familiar with when a dependent ceases t be a dependent under the terms f the plan. The Cunty f Kern will ntify the plan administratr f the emplyee s terminatin f emplyment, reductin f hurs, death, r Medicare entitlement. In the case f ther events, the respnsibility t prvide ntice is yurs. Electin Perid and Cverage Once the plan administratr learns a qualifying event has ccurred, the plan administratr will ntify cvered individuals (als knwn as qualified beneficiaries) f their rights t elect cntinuatin cverage. The 60-day electin windw is measured frm the later f the date health plan cverage is lst due t the event r frm the date f the COBRA ntificatin. This is the maximum perid allwed t elect COBRA as the plan des nt prvide an extensin f the electin perid beynd what is required by law. If a qualified beneficiary des nt elect cntinuatin cverage within this electin perid, then rights t cntinue health insurance will end and they will cease t be a qualified beneficiary. If a qualified beneficiary elects cntinuatin cverage, they will be required t pay the entire cst fr the health insurance, plus a 2% administratin fee. The Cunty f Kern is required t prvide the qualified beneficiary cverage that is identical t the cverage prvided under the plan t similarly situated nn-cobra participants and/r cvered dependents. Shuld cverage be mdified fr nn-cobra participants, then the mdificatin will be made t yur cverage as well. Length f Cntinuatin Cverage 18 Mnths. If the event causing the lss f cverage is terminatin f emplyment (ther than fr reasns f grss miscnduct) r a reductin in wrk hurs, then each qualified beneficiary will have the pprtunity t cntinue cverage fr 18 mnths frm the date f the qualifying event. Scial Security Disability The 18 mnths f cntinuatin cverage can be extended fr an additinal 11 mnths, t a maximum f 29 mnths, fr all qualified beneficiaries, if the Scial Security Administratin determines a qualified beneficiary was disabled accrding t Title II r XVI f the Scial Security act n the date f the qualifying event r at any time during the first 60 days f cntinuatin cverage. In the case f a newbrn r adpted child that is added t a cvered emplyee s COBRA cverage, the first 60 days f cntinuatin cverage fr the newbrn r adpted child is measured frm the date f the birth r the date f adptin. It is the qualified beneficiary s respnsibility t btain disability determinatin frm the Scial Security Administratin and prvide a cpy f the Scial Security Disability determinatin (cmmnly knwn as a Ntice f Award ) t the Plan Administratr within 60 days f the date f the determinatin and befre the riginal 18 mnths f COBRA expire. This extensin applies separately t each qualified beneficiary. If the disabled qualified beneficiary chses nt t cntinue cverage, the ther qualified beneficiaries are still eligible fr the extensin. If cverage is extended, and the disabled qualified beneficiary has elected the extensin, then the applicable premium rate is 150% f the grup rate. If nly nn-disabled qualified beneficiaries extend cverage, the premium rate will remain at the 102% level. It is als the qualified beneficiary s respnsibility t ntify the Plan Administratr within 30 days if a final determinatin has been made that they are n lnger disabled. Secndary Events An extensin f the riginal 18, r abve mentined 29 mnth, cntinuatin perid can als ccur, if during the 18 r 29 mnths f cntinuatin cverage, a secnd event takes place (divrce, legal separatin, death, Medicare Entitlement, r a dependent child ceasing t be a dependent). If a secnd event ccurs, then the riginal 18 r 29 mnths f cntinuatin cverage will be extended t 36 mnths frm the date f the riginal qualifying event date fr eligible dependent qualified beneficiaries. If a secnd event ccurs, it is the qualified beneficiary s respnsibility t ntify the Plan Administratr in writing within 60 days f the secnd event and within the riginal 18 mnth COBRA timeline. In n event, hwever, will cntinuatin cverage last beynd three years frm the date f the event that riginally made the qualified beneficiary eligible fr cntinuatin cverage. A reductin in hurs fllwed by a terminatin f emplyment is nt cnsidered a secnd event fr COBRA purpses. Length f Cntinuatin Cverage 36 mnths. If the riginal event causing the lss f cverage was the death f the emplyee, divrce, legal separatin, Medicare entitlement, r a dependent child ceasing t be a dependent child under the Cunty f Kern Health Plans, then each qualified beneficiary will have the pprtunity t cntinue cverage fr 36 mnths frm the date f the qualifying event. Adult Child turning Age 26 Ntice: Yu will n lnger be eligible fr cverage because f yur age. Yu have 60 days frm the date f the ntice t ntify us that yu wish t cntinue cverage under the federal COBRA law. 5
If yu d nt ntify us f the chice yu have made within 60 days, yur cverage will end as f yur 26 th birthday. Eligibility, Premiums, and Ptential Cnversin Rights A qualified beneficiary des nt have t shw they are insurable t elect cntinuatin cverage, hwever, the must have been actually cvered by the plan n the day befre the event t be eligible fr COBRA cntinuatin cverage. An exceptin t this rule is if while n cntinuatin cverage a baby is brn t r adpted by a cvered emplyee qualified beneficiary. If this ccurs, the newbrn r adpted child ban be added t the plan and will gain the rights f ther qualified beneficiaries. The COBRA timeline fr the newbrn r adpted child is measured frm the date f the riginal qualifying event. Prcedures and timelines fr adding these individuals can be fund in yur benefits bklets and must be fllwed. The plan administratr reserves the right t verify COBRA eligibility status and terminate cntinuatin cverage retractively if yu are determined t be ineligible r if there has been a material misrepresentatin f the facts. A qualified beneficiary must pay all f the applicable premiums plus a 2% administratin charge fr cntinuatin cverage. These premiums will be adjusted during the cntinuatin perid if the applicable premium amunt changes. In additin, if cntinuatin cverage is extended frm 18 mnths t 29 mnths due t a Scial Security disability, the Cunty f Kern can charge up t 150% f the applicable premium during the extended cverage perid. Qualified beneficiaries will be allwed t pay n a mnthly basis. In additin, there will be a maximum grace perid f (30) days fr the regularly scheduled mnthly premiums. At the end f the 18, 29, r 36 mnths f cntinuatin cverage, a qualified beneficiary must be allwed t enrll in an individual cnversin health plan prvided under the Cunty Health Plans if an individual cnversin plan is available at that time. Currently, n individual cnversin plans exist. Cancellatin f Cntinuatin Cverage The law prvides COBRA cntinuatin cverage will end prir t the maximum cntinuatin cverage perid fr any f the fllwing reasns: The Cunty f Kern ceases t prvide any grup health plan t any f its emplyees; Any required premium fr cntinuatin cverage is nt paid in a timely manner; A qualified beneficiary first becmes, after the date f COBRA electin, cvered under anther grup health plan that des nt cntain any exclusin r limitatin with respect t any preexisting cnditin f such beneficiary ther than an exclusin r limitatin which des nt apply t r is satisfied by such beneficiary by reasn f the Health Insurance Prtability Act f 1996; A qualified beneficiary first becmes, after the date f COBRA electin, entitled t Medicare; A qualified beneficiary extended cntinuatin cverage t 29 mnths due t a Scial Security disability and a final determinatin has been made that the qualified beneficiary is n lnger disabled; A qualified beneficiary ntifies the plan administratr they wish t cancel COBRA cntinuatin cverage. Ntificatin f Address Change T insure all cvered individuals receive infrmatin prperly and efficiently, it is imprtant yu ntify Kern Cunty Human Resurces Emplyee Benefits f any address change as sn as pssible. Failure n yur part t d s will result in delayed COBRA ntificatins r a lss f cntinuatin cverage ptins. Any Questins? Remember, this ntice is simply a summary f yur ptential future ptins under COBRA. Shuld an actual qualifying event ccur, f which Kern Cunty Human Resurces Health Benefits is timely ntified, and it is determined that yu are eligible fr COBRA, yu will be ntified f yur actual COBRA rights at that time. 6
Kern Cunty HR Cunty Administrative Office 1115 Truxtun Avenue, 1st Flr, Bakersfield, CA 93301 Telephne (661) 868-3480 Fax (661) 868-3928 Ryan J. Alsp Cunty Administrative Officer Devin W. Brwn Chief Human Resurces Officer T: All participants in Cunty f Kern Health Benefit plans Re: HIPAA PRIVACY POLICY In 1996, the Health Insurance Prtability and Accuntability Act (HIPAA), Public Law 104-191, was enacted t increase access t and the efficiency f the healthcare system in the United States. This rule prvides cmprehensive federal prtectin fr the privacy f health infrmatin. It creates natinal standards t prtect individuals= medical recrds and ther persnal health infrmatin and gives patients mre cntrl ver their health infrmatin. It sets limits n the use and release f health recrds. It sets ut safeguards that prviders and health plans must implement t prtect the privacy f health infrmatin. In general, it states that a cvered entity may nt use r disclse an individual s healthcare infrmatin withut permissin except fr treatment, payment, r healthcare peratins. Attached is the HIPAA Privacy Plicy fr the Cunty emplyee health benefit plan. As required by the law, it is being distributed t yu because yu are a participant in a Cunty f Kern health benefit plan. Shuld yu have questins regarding the Cunty plicy, cntact Kern Cunty Human Resurces Health Benefits at (661) 868-3182. Sincerely, Devin W. Brwn Emplyee Benefits Privacy Officer 7
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COUNTY OF KERN EMPLOYEE HEALTH BENEFIT PLANS PRIVACY POLICY AND NOTICE Summary (Fr infrmatinal purpses nly; fr details, please refer t the full plicy which appears after this ne page summary.) The Kern Cunty Plans are required t maintain the privacy f prtected health infrmatin, which includes any identifiable infrmatin that the plan administratrs btain frm yu r thers that relates t yur health, yur health care, r payment fr yur health care. Use f Prtected Health Infrmatin The Kern Cunty Plans can use r disclse yur prtected health infrmatin fr purpses f health care treatment, health care payment and health care peratins, as described belw in the full ntice. The Kern Cunty Plans may cntact yu t prvide infrmatin abut treatment alternatives r ther health related benefits and services. The Kern Cunty Plans may disclse yur prtected health infrmatin t yur family r friends r any ther individual identified by yu. The Kern Cunty Plans will nly disclse the prtected health infrmatin directly relevant t the plan administratr s invlvement in yur care r payment f claims fr yur treatment. Except fr exceptinal situatins, the Kern Cunty Plans will nt use r disclse yur prtected health infrmatin fr any ther purpse unless yu prvide written authrizatin. Yu have the right t revke that authrizatin at any time. YOUR RIGHTS Yu have the right t request restrictins n the uses and disclsures f prtected health infrmatin, but the Kern Cunty Plans administratrs are nt required t agree t yur request. Yu have the right t request t receive cmmunicatins f prtected health infrmatin by alternative means r at alternative lcatins. With sme exceptins detailed in the full ntice, yu have the right t inspect and cpy the prtected health infrmatin cntained in the plan s recrds. Yu may request an amendment t yur prtected health infrmatin, but the plan may deny yur request. Yu have the right t receive an accunting f disclsures f prtected health infrmatin made by the plan. Yu have the right t receive a paper cpy f this ntice FILING A COMPLAINT If yu believe that yur privacy rights have been vilated, yu shuld immediately cntact Devin W. Brwn, ur privacy fficer at (661) 868-3182. Alternatively, yu may cmplain t the Secretary f the U.S. Department f Health and Human Services, generally, within 180 days f when the act r missin ccurred. CONTACT PERSON If yu have any questins r wuld like further infrmatin abut this ntice, please cntact Devin W. Brwn at (661) 868-3182. 9
COUNTY OF KERN EMPLOYEE HEALTH BENEFIT PLANS PRIVACY POLICY AND NOTICE This plicy describes hw medical infrmatin abut yu may be used and disclsed and hw yu can get access t this infrmatin. Please review it carefully. The Kern Cunty Plans are required by law t maintain the privacy f prtected health infrmatin. Prtected health infrmatin includes any identifiable infrmatin that the administratrs f the plan btain frm yu r thers that relates t yur physical r mental health, the health care yu have received, r payment fr yur health care. As required by law, this ntice prvides yu with infrmatin abut yur rights and the legal duties and privacy practices with respect t the privacy f prtected health infrmatin. This ntice als discusses the uses and disclsures Kern Cunty Plans will make f yur prtected health infrmatin. The Kern Cunty Plans reserve the right t change the terms f this ntice frm time t time and t make the revised ntice effective fr all prtected health infrmatin the plan administratrs maintain. Yu can always request a cpy f ur mst current privacy ntice frm ur ffice r yu can access it n ur Web site, www.kerncuntyhealthbenefits.cm under Plicies and Ntices. PERMITTED USES AND DISCLOSURES The Kern Cunty Plans can use r disclse yur prtected health infrmatin fr purpses f treatment, payment and health care peratins. Treatment means the prvisin, crdinatin r management f yur health care, including referrals fr health care frm ne health care prvider t anther. Fr example, a prvider under the Kern Cunty Plans may need t knw health care infrmatin in plan files that might assist in treatment. Payment means activities t btain and prvide reimbursement fr the health care prvided t yu, including determinatins f eligibility and cverage and ther utilizatin review activities. Fr example, the infrmatin n r accmpanying health care bills sent t the plan may include infrmatin that identifies yu as well as yur diagnsis, prcedures, and supplies used. As anther example, prir t prviding health care services, the Kern Cunty Plans may need infrmatin frm a prvider abut yur medical cnditin t determine whether the prpsed curse f treatment will be cvered. When the plan receives a bill frm the prvider, the Kern Cunty Plans can btain infrmatin regarding yur care if necessary t prvide payment. Health care peratins means the supprt functins related t treatment and payment, such as quality assurance activities, case management, receiving and respnding t patient cmplaints, physician reviews, cmpliance prgrams, audits, business planning, develpment, management and administrative activities. Fr example, the plan administratrs may use yur medical infrmatin t evaluate the perfrmance f prviders used in ur plan. The plan administratrs may als cmbine medical infrmatin abut many patients t decide hw t better prvide needed benefits under the plan. 10
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION The Kern Cunty Plans may cntact yu t prvide infrmatin abut treatment alternatives r ther health related benefits and services that may be f interest t yu. The Kern Cunty Plans may disclse yur prtected health infrmatin t yur family r friends r any ther individual identified by yu when they are invlved in yur care r the payment f yur care. The Kern Cunty Plans will nly disclse the prtected health infrmatin directly relevant t their invlvement in yur care r payment. The Kern Cunty Plans may als use r disclse yur prtected health infrmatin t ntify, r assist in the ntificatin f, a family member, a persnal representative, r anther persn respnsible fr yur care r yur lcatin, general cnditin, r death. If yu are available, the Kern Cunty Plans will give yu an pprtunity t bject t these disclsures, and the plan will nt make these disclsures if yu bject. If yu are nt available, the Kern Cunty Plans will determine whether a disclsure t yur family r friends is in yur best interest, and the plan will disclse nly the prtected health infrmatin that is directly relevant t their invlvement in yur care. When permitted by law, the Kern Cunty Plans may crdinate ur uses and disclsures f prtected health infrmatin with public r private entities authrized by law r by charter t assist in disaster relief effrts. Except fr the situatins set frth belw, the Kern Cunty Plans will nt use r disclse yur prtected health infrmatin fr any ther purpse unless yu prvide written authrizatin. Yu have the right t revke that authrizatin at any time, prvided that the revcatin is in writing, except t the extent that the Kern Cunty Plan(s) already have taken actin in reliance n yur authrizatin. EXCEPTIONAL SITUATIONS The plan administratrs may use r disclse yur prtected health infrmatin in the fllwing situatins withut yur authrizatin: Crners, Medical Examiners and Funeral Directrs. The plan administratrs may release medical infrmatin t a crner r medical examiner. This may be necessary, fr example, t identify a deceased persn r determine the cause f death. The plan administratrs may als release medical infrmatin abut patients t funeral directrs as necessary t carry ut their duties. Health Oversight Activities. The plan administratrs may disclse medical infrmatin t federal r state agencies that versee ur activities. The activities are necessary fr the gvernment t mnitr the health care system, gvernment prgrams, and cmpliance with civil rights laws. The plan administratrs may disclse prtected health infrmatin t persns under the Fd and Drug Administratin s jurisdictin t track prducts r t cnduct pst-marketing surveillance. Inmates. If yu becme an inmate f a crrectinal institutin r fall under the custdy f a law enfrcement fficial, the plan may release medical infrmatin abut yu t the crrectinal institutin r law enfrcement fficial. This release wuld be necessary fr the institutin t prvide yu with health care; t prtect yur health and safety r the health and safety f thers; r fr the safety and security f the crrectinal institutin. Law Enfrcement. The plan administratrs may release medical infrmatin in these situatins; if asked t d s by a law enfrcement fficial in respnse t a curt rder, subpena, warrant, summns, r 11
similar prcess; t identify r lcate a suspect, fugitive, material witness, r missing persn; abut the victim f a crime if, under certain limited circumstances, the plan administratrs are unable t btain the persn s agreement; abut a death the plan administratrs believe may be the result f criminal cnduct; abut criminal cnduct n ur premises; and in emergency circumstances t reprt a crime; the lcatin f the crime r victims r the identity, descriptin r lcatin f the persn wh cmmitted the crime. Lawsuits and Disputes. If yu are invlved in a lawsuit r a dispute, the plan administratrs may disclse medical infrmatin abut yu in respnse t a curt r administrative rder. The plan administratrs may als disclse medical infrmatin abut yu in respnse t a subpena, discvery request, r ther lawful prcess by smene else invlved in the dispute, but nly if effrts have been made t tell yu abut the request r t btain an rder prtecting the infrmatin requested. Military and Veterans. If yu are a member f the armed frces, the plan administratrs may release medical infrmatin abut yu as required by military cmmand authrities. The plan administratrs may als release medical infrmatin abut freign military persnnel t the apprpriate freign military authrity. Natinal Security and Intelligence Activities. The plan administratrs may release medical infrmatin abut yu t authrized federal fficials fr intelligence, cunterintelligence, r ther natinal security activities authrized by law. Organ and Tissue Dnatin. If yu are an rgan dnr, the plan administratrs may release medical infrmatin t rganizatins that handle rgan prcurement r rgan, eye r tissue transplantatin r t an rgan dnatin bank, as necessary t facilitate rgan r tissue dnatin and transplantatin. Prtective Services fr the President and Others. The plan administratrs may disclse medical infrmatin abut yu t authrized federal fficials s they may prvide prtectin t the President, ther authrized persns r fresight heads f state r cnduct special investigatins, as authrized by law. Public Health Risks. The plan administratrs may disclse medical infrmatin abut yu fr public health activities. These activities generally include the fllwing: t prevent r cntrl disease, injury r disability; t reprt births and deaths; t reprt child abuse r neglect; t reprt reactins t medicatins r prblems with a prduct; t ntify peple f prduct recalls, repairs r replacement; t ntify a persn wh may have been expsed t a disease r may be at risk fr cntracting r spreading a disease r cnditin; t ntify the apprpriate gvernment authrity if the plan administratrs believe a patient has been the victim f abuse, neglect r dmestic vilence. The plan administratrs will nly make this disclsure if yu agree r when required r authrized by law. Serius Threats. As permitted by applicable law and standards f ethical cnduct, the plan administratrs may use and disclse prtected health infrmatin if the plan administratrs, in gd faith believe that the use f disclsure is necessary t prevent r lessen a serius and imminent threat t the health r safety f a persn r the public. Wrkers Cmpensatin. The plan administratrs may release medical infrmatin abut yu fr prgrams that prvide benefits fr wrk-related injuries r illnesses. YOUR RIGHTS Yu have the right t request restrictins n the Kern Cunty Plans uses and disclsures f prtected health infrmatin fr treatment, payment and health care peratins. Hwever, the Kern Cunty Plans are nt required t agree t yur request. Yu have the right t reasnably request t receive cmmunicatins f prtected health infrmatin by alternative means r at alternative lcatins. Subject t payment f a reasnable cpying charge (if yu cannt affrd t pay fr cpies, yu will nt be denied access), yu have the right t inspect and cpy the prtected health infrmatin 12
cntained in the plan s recrds, except fr psychtherapy ntes; infrmatin cmpiled in reasnable anticipatin f, r use in, a civil, criminal, r administrative actin r prceeding, and prtected health infrmatin that is subject t law that prhibits access t prtected health infrmatin. Depending n the circumstances, a decisin t deny access may be reviewable. In sme circumstances, yu may have a right t have this decisin reviewed by the Privacy Officer. Yu have the right t request an amendment t yur prtected health infrmatin, but the Kern Cunty Plans may deny yur request. Any agreed upn amendment will be included as an additin t, and nt a replacement f, already existing recrds. Yu have the right t receive an accunting f disclsures f prtected health infrmatin made by the plan t individuals r entities ther than t yu, except fr disclsures t carry ut treatment, payment and health care peratins as prvided abve; t persns invlved in yur care r fr ther ntificatins purpses as prvided by law; fr natinal security r intelligence purpses as prvided by law; t crrectinal institutins r law enfrcement fficials as prvided by law; r that ccurred prir t April 14, 2003. Yu have the right t request and receive a paper cpy f this ntice frm the Kern Cunty Human Resurces. 13
Imprtant Ntice Abut Medicare and Yur Prescriptin Drug Cverage frm the Cunty f Kern Emplyee Medical Benefit Plans This ntice applies nly t persns enrlled in the Cunty f Kern Emplyee Medical Benefit Plans: Cunty f Kern POS Plan, Cunty f Kern EPO Plan, Kaiser Permanente and Kern Legacy Health Plan Netwrk Plus. Please read this ntice carefully and keep it where yu can find it. This ntice has infrmatin abut yur current prescriptin drug cverage with the Cunty and the prescriptin drug cverage that became available January 1, 2006 fr peple with Medicare. It als tells yu where t find mre infrmatin t help yu make decisins abut yur prescriptin drug cverage. 1. Beginning January 1, 2006, Medicare prescriptin drug cverage became available t everyne with Medicare. 2. The Cunty has determined that the prescriptin drug cverage ffered by the Cunty f Kern Emplyee Medical Benefit Plans is, n average fr all plan participants, expected t pay ut as much as the standard Medicare prescriptin drug cverage will pay. 3. Read this ntice carefully - it explains the ptins yu have under Medicare prescriptin drug cverage, and can help yu decide whether r nt yu want t enrll. Yu may have heard abut Medicare s new prescriptin drug cverage, and wndered hw it wuld affect yu. The Cunty has determined that yur prescriptin drug cverage with the Cunty f Kern Emplyee Medical Benefit Plan is, n average fr all plan participants, expected t pay ut as much as the standard Medicare prescriptin drug cverage will pay. Starting January 1, 2006, prescriptin drug cverage became available t everyne with Medicare thrugh Medicare prescriptin drug plans. All Medicare prescriptin drug plans must prvide at least a standard level f cverage set by Medicare. Sme plans might als ffer mre cverage fr a higher mnthly premium. Because yur existing cverage is n average at least as gd as standard Medicare prescriptin drug cverage, yu can keep this cverage and nt pay extra if yu later decide t enrll in Medicare cverage. Peple with Medicare may enrll in a Medicare prescriptin drug plan during perids set by Medicare (CMS), typically Nvember 15 th thrugh December 31 st each year. Hwever, because yu have existing prescriptin drug cverage that, n average, is as gd as Medicare cverage, yu can chse t jin a Medicare prescriptin drug plan later. If yu d decide t enrll in a Medicare prescriptin drug plan and drp yur prescriptin drug cverage thrugh the Cunty, be aware that yu may nt be able t get this cverage back. If yu drp yur cverage with the Cunty and enrll in a Medicare prescriptin drug plan, yu may nt be able t get this cverage back later. Yu shuld cmpare yur current cverage, including which drugs are cvered, with the cverage and cst f the plans ffering Medicare prescriptin drug cverage in yur area. In additin, yur current cverage pays fr ther health expenses, in additin t prescriptin drugs. Yu will nt still be eligible t receive all f yur current health and prescriptin drug benefits if yu chse t enrll in a Medicare prescriptin drug plan. 14
Fr anyne wh is Medicare eligible, yu shuld knw that if yu drp r lse yur cverage with the Cunty and dn t enrll in Medicare prescriptin drug cverage after yur current cverage ends, yu may pay mre t enrll in Medicare prescriptin drug cverage later. If after May 15, 2006, yu g 63 days r lnger withut prescriptin drug cverage that s at least as gd as Medicare s prescriptin drug cverage; yur mnthly premium will g up at least 1% per mnth fr every mnth after May 15, 2006 that yu did nt have that cverage. Fr example, if yu g nineteen mnths withut cverage, yur premium will always be at least 19% higher than what mst ther peple pay. Yu ll have t pay this higher premium as lng as yu have Medicare cverage. In additin, yu may have t wait until next Nvember t enrll. Fr mre infrmatin abut this ntice r yur current prescriptin drug cverage: If yu have questins abut yur current prescriptin drug cverage. Cntact Kern Cunty Human Resurces if yu have questins abut why yu received this ntice. NOTE: Yu may receive this ntice at ther times in the future such as befre the next perid yu can enrll in Medicare prescriptin drug cverage, and/r if this cverage changes. Yu als may request a cpy. Fr mre infrmatin abut yur ptins under Medicare prescriptin drug cverage: Mre detailed infrmatin abut Medicare plans that ffer prescriptin drug cverage are available in the Medicare & Yu handbk. Medicare eligible persn gets a cpy f the handbk in the mail frm Medicare. Yu may als be cntacted directly by Medicare prescriptin drug plans. Yu can als get mre infrmatin abut Medicare prescriptin drug plans frm these places: Visit www.medicare.gv fr persnalized help. Call yur State Health Insurance Assistance Prgram (see yur cpy f the Medicare & Yu handbk fr their telephne number). Call 1-800-MEDICARE (1-800-633-4227). TTY users shuld call 1-877-486-2048. Kern Cunty s Aging & Adult Services HICAP Prgram at (661) 868-1000. Fr peple with limited incme and resurces, extra help paying fr a Medicare prescriptin drug plan is available. Infrmatin abut this extra help is available frm the Scial Security Administratin (SSA). Fr mre infrmatin abut this extra help, visit SSA nline at www.scialsecurity.gv, r call them at 1-800-772-1213 (TTY 1-800-325-0778). Remember: Keep this ntice. If yu enrll in ne f the plans apprved by Medicare which ffer prescriptin drug cverage, yu may need t give a cpy f this ntice when yu jin t shw that yu are nt required t pay a higher premium amunt. Date: December 2016 Name f Entity/Sender: Cunty f Kern Emplyee Medical Benefit Plans Cntact--Psitin/Office: Kern Cunty Human Resurces Address: 1115 Truxtun Avenue, 1st Flr; Bakersfield, CA 93301 Phne Number: (661) 868-3182 E-mail Address: healthbenefits@kerncunty.cm 15
These ntices are prvided t yu as required by the HealthCare Refrm laws. Wmen s Health & Cancer Rights Act The Wmen s Health and Cancer Rights Act f 1998 requires all emplyers spnsred health plan that cver mastectmies t al cver relate recnstructive surgery. Available recnstructive surgery must include bth recnstructin f the breast n which surgery was perfrmed, and surgery and recnstructin f the ther breast t prduce a symmetrical appearance. Cverage must als be available fr breast prstheses and fr the physical cmplicatins f mastectmy, including lynphedemas. Yur Cunty f Kern medical plans already prvides benefits fr these mastectmy related services while cvered under the health plans. Under the law, we are required t ntify yu annually f these rights. This ntice merely reminds yu and yur cvered family members that these benefits are available, in cmpliance with the ntice requirements f the Wmen s Health and Cvered Rights Act f 1998. If yu have any questins abut cvered services, please cntact yur health plans custmer service number at: Cunty f Kern POS (Pint-Of-Service) Plan: 1-855-537-6767 Cunty f Kern EPO (Exclusive Prvider Organizatin) Plan: 1-800-587-8810 r 661-716-3450 Kaiser Permanente: 1-800-464-4600 Kern Legacy Health Plan Netwrk Plus : 1-855-308-5547 r 661-868-3281, Optin 5 Lifetime Limits (Eliminatin) - Disclsure Ntice The lifetime limit n the dllar value f benefits under Cunty f Kern active emplyee medical plans n lnger applies. Individuals whse cverage ended by reasn f reaching a lifetime limit under the plan are eligible t enrll in the plan. Fr mre infrmatin cntact yur medical plan. Cntact infrmatin fr each plan is lcated at www.kerncuntyhealthbenefits.cm r yu may cntact Kern Cunty Human Resurces Emplyee Benefits at (661) 868-3182 fr the apprpriate medical plan phne number. 16
These ntices are prvided t yu as required by the HealthCare Refrm laws. Patient Prtectin (Primary Care Physician/OB-GYN) - Disclsure Ntice The Cunty f Kern medical plans generally require the designatin f a primary care prvider. Yu have the right t designate any primary care prvider wh participates in ur netwrk and wh is available t accept yu r yur family members. Fr infrmatin n hw t select a primary care prvider, and fr a list f the participating primary care prviders, cntact yur medical plan. Cntact infrmatin fr each plan is lcated at www.kerncuntyhealthbenefits.cm r yu may cntact Kern Cunty Human Resurces Health Benefits at (661) 868-3182 fr the apprpriate medical plan phne number. Fr children, yu may designate a pediatrician as the primary care prvider. Yu d nt need prir authrizatin frm the Cunty f Kern medical plans r frm any ther persn (including a primary care prvider) in rder t btain access t bstetrical r gyneclgical care frm a health care prfessinal in ur netwrk wh specializes in bstetrics r gyneclgy. The health care prfessinal, hwever, may be required t cmply with certain prcedures, including btaining prir authrizatin fr certain services, fllwing a pre-apprved treatment plan, r prcedures fr making referrals. Fr a list f participating health care prfessinals wh specialize in bstetrics r gyneclgy, cntact yur medical plan. Cntact infrmatin fr each plan is lcated at www.kerncuntyhealthbenefits.cm r yu may cntact Kern Cunty Human Resurces Health Benefits at (661) 868-3182 fr the apprpriate medical plan phne number. Extensin f Dependent Cverage t Age 26 This ntice is a reminder abut the HealthCare Refrm laws passed in 2010. Yu may add r re-enrll children (including stepchildren, fster children, and guardianship children) wh are under age 26 nt yur health benefits cverage during this Open Enrllment. The children d nt need t be in schl, they d nt have t live with yu; it des nt matter if they are disabled, yu d nt have t have custdy, yu d nt have t prvide their supprt, and they may be married. Yu may add them even if they ve never been cvered befre r if an adult child is ffered cverage by their wn emplyer, r their spuse s emplyer. Changes fr cvered children are nt allwed utside f pen enrllment fr changes in schl enrllment status, marital status, custdy status, supprt status, residence, etc. Nte: This rule applies t active emplyee health benefit cverage, but des nt apply t retiree cverage. 17
Medicaid and the Children s Health Insurance Prgram (CHIP) Offer Free Or Lw-Cst Health Cverage T Children And Families If yu are eligible fr health cverage frm yur emplyer, but are unable t affrd the premiums, sme States have premium assistance prgrams that can help pay fr cverage. These States use funds frm their Medicaid r CHIP prgrams t help peple wh are eligible fr emplyer-spnsred health cverage, but need assistance in paying their health premiums. If yu r yur dependents are already enrlled in Medicaid r CHIP and yu live in a State listed belw, yu can cntact yur State Medicaid r CHIP ffice t find ut if premium assistance is available. If yu r yur dependents are NOT currently enrlled in Medicaid r CHIP, and yu think yu r any f yur dependents might be eligible fr either f these prgrams, yu can cntact yur State Medicaid r CHIP ffice r dial 1-877-KIDS NOW r www.insurekidsnw.gv t find ut hw t apply. If yu qualify, yu can ask the State if it has a prgram that might help yu pay the premiums fr an emplyer-spnsred plan. Once it is determined that yu r yur dependents are eligible fr premium assistance under Medicaid r CHIP, yur emplyer s health plan is required t permit yu and yur dependents t enrll in the plan as lng as yu and yur dependents are eligible, but nt already enrlled in the emplyer s plan. This is called a special enrllment pprtunity, and yu must request cverage within 60 days f being determined eligible fr premium assistance. If yu live in ne f the fllwing States, yu may be eligible fr assistance paying yur emplyer health plan premiums. The fllwing list f States is current as f September 1, 2010. Yu shuld cntact yur State fr further infrmatin n eligibility. CALIFORNIA -Medi-Cal Website: http://www.dhcs.ca.gv/services/pages/ TPLRD_CAU_cnt.aspx Phne: 1-866-298-8443 ALABAMA - Medicaid Website: http://www.medicaid.alabama.gv Phne: 1-800-362-1504 ALASKA - Medicaid Website: http://health.hss.state.ak.us/dpa/prgrams/medicaid/ Phne (Outside f Anchrage): 1-888-318-8890 Phne (Anchrage): 907-269-6529 COLORADO Medicaid and CHIP Medicaid Website: http://www.clrad.gv/ Medicaid Phne: 1-800-866-3513 CHIP Website: http:// www.chpplus.rg CHIP Phne: 303-866-3243 ARIZONA CHIP Website: http://www.azahcccs.gv/applicants/default.aspx Phne: 1-877-764-5437 ARKANSAS CHIP Website: http://www.arkidsfirst.cm/ Phne: 1-888-474-8275 MINNESOTA Medicaid Website: http://www.dhs.state.mn.us/ Click n Health Care, then Medical Assistance Phne (Outside f Twin City area): 800-657-3739 Phne (Twin City area): 651-431-2670 18
FLORIDA Medicaid Website: http://www.fdhc.state.fl.us/medicaid/index.shtml Phne: 1-866-762-2237 GEORGIA Medicaid Website: http://dch.gergia.gv/ Click n Prgrams, then Medicaid Phne: 1-800-869-1150 IDAHO Medicaid and CHIP Medicaid Website: www.accessthealthinsurance.idah.gv Medicaid Phne: 1-800-926-2588 CHIP Website: www.medicaid.idah.gv CHIP Phne: 1-800-926-2588 INDIANA Medicaid Website: http://www.in.gv/fssa/2408.htm Phne: 1-877-438-4479 IOWA Medicaid Website: www.dhs.state.ia.us/hipp/ Phne: 1-888-346-9562 KANSAS Medicaid Website: https://www.khpa.ks.gv Phne: 800-766-9012 KENTUCKY Medicaid Website: http://chfs.ky.gv/dms/default.htm Phne: 1-800-635-2570 LOUISIANA Medicaid Website: http://www.lahipp.dhh.luisiana.gv Phne: 1-888-342-6207 MAINE Medicaid Website: http://www.maine.gv/dhhs/ms/ Phne: 1-800-321-5557 MONTANA Medicaid Website: http://medicaidprvider.hhs.mt.gv/clientpages/ clientindex.shtml Telephne: 1-800-694-3084 NEBRASKA Medicaid Website: http://www.dhhs.ne.gv/med/medindex.htm Phne: 1-877-255-3092 NEVADA Medicaid and CHIP Medicaid Website: http://dwss.nv.gv/ Medicaid Phne: 1-800-992-0900 CHIP Website: http://www.nevadacheckup.nv.rg/ CHIP Phne: 1-877-543-7669 NEW HAMPSHIRE Medicaid Website: http://www.dhhs.state.nh.us/dhhs/ MEDICAIDPROGRAM/default.htm Phne: 1-800-852-3345 x 5254 NEW JERSEY Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phne: 1-800-356-1561 CHIP Website: http://www.njfamilycare.rg/index.html CHIP Phne: 1-800-701-0710 NEW MEXICO Medicaid and CHIP Medicaid Website: http://www.hsd.state.nm.us/mad/index.html Medicaid Phne: 1-888-997-2583 CHIP Website: http://www.hsd.state.nm.us/mad/index.html Click n Insure New Mexic CHIP Phne: 1-888-997-2583 MASSACHUSETTS Medicaid and CHIP Medicaid & CHIP Website: http://www.mass.gv/masshealth Medicaid & CHIP Phne: 1-800-462-1120 NEW YORK Medicaid Website: http://www.nyhealth.gv/health_care/ medicaid/ Phne: 1-800-541-2831 MISSOURI Medicaid Website: http://www.dss.m.gv/mhd/index.htm Phne: 573-751-6944 19
NORTH CAROLINA Medicaid Website: http://www.nc.gv Phne: 919-855-4100 NORTH DAKOTA Medicaid Website: http://www.nd.gv/dhs/services/medicalserv/medicaid/ Phne: 1-800-755-2604 OKLAHOMA Medicaid Website: http://www.insureklahma.rg Phne: 1-888-365-3742 OREGON Medicaid and CHIP Medicaid & CHIP Website: http://www.regnhealthykids.gv Medicaid & CHIP Phne: 1-877-314-5678 PENNSYLVANIA Medicaid Website: http://www.dpw.state.pa.us/partnersprviders/medicala ssistance/dingbusiness/003670053.htm Phne: 1-800-644-7730 RHODE ISLAND Medicaid Website: www.dhs.ri.gv Phne: 401-462-5300 SOUTH CAROLINA Medicaid Website: http://www.scdhhs.gv Phne: 1-888-549-0820 TEXAS Medicaid Website: https://www.gethipptexas.cm/ Phne: 1-800-440-0493 UTAH Medicaid Website: http://health.utah.gv/medicaid/ Phne: 1-866-435-7414 VERMONT Medicaid Website: http://vha.vermnt.gv/ Telephne: 1-800-250-8427 VIRGINIA Medicaid and CHIP Medicaid Website: http://www.dmas.virginia.gv/rcp-hipp.htm Medicaid Phne: 1-800-432-5924 CHIP Website: http://www.famis.rg/ CHIP Phne: 1-866-873-2647 WASHINGTON Medicaid Website: http://hrsa.dshs.wa.gv/premiumpymt/apply.shtm Phne: 1-877-543-7669 WASHINGTON Medicaid Website: http://hrsa.dshs.wa.gv/premiumpymt/apply.shtm Phne: 1-877-543-7669 WEST VIRGINIA Medicaid Website: http://www.wvrecvery.cm/hipp.htm Phne: 304-342-1604 WISCONSIN Medicaid Website:http://dhs.wiscnsin.gv/medicaid/publicati ns/p-10095.htm Phne: 1-800-362-3002 WYOMING Medicaid Website: http://www.health.wy.gv/healthcarefin/index.html Telephne: 307-777-7531 T see if any mre States have added a premium assistance prgram since September 1, 2010, r fr mre infrmatin n special enrllment rights, yu can cntact either: U.S. Department f Labr U.S. Department f Health and Human Services Emplyee Benefits Security Administratin Centers fr Medicare & Medicaid Services www.dl.gv/ebsa www.cms.hhs.gv 1-866-444-EBSA (3272) 1-877-267-2323, Ext. 61565 OMB Cntrl Number 1210-0137 (expires 09/30/2013) 20
Kern Cunty HR Cunty Administrative Office 1115 Truxtun Avenue, 1st Flr, Bakersfield, CA 93301 Telephne (661) 868-3480 Fax (661) 868-3928 Ryan J. Alsp Cunty Administrative Officer Devin W. Brwn Chief Human Resurces Officer HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGE This dcument is a required disclsure as part f the Affrdable Care Act, infrming yu f the new health insurance marketplace, Cvered Califrnia. Part A: General Infrmatin The federal Affrdable Care Act (ACA), ften called health care refrm, has been in place since 2010. Health care refrm has already caused sme changes t yur medical plan benefits, such as free preventive care, n lifetime dllar-amunt benefit limits, and additinal reprting n frm W-2 shwing the value f health plan cverage. Even bigger changes will g int effect sn, such as the pening f the new state-based insurance marketplace, Cvered Califrnia, and the requirement that mst Americans have health insurance starting January 1, 2014. Q: Des health care refrm mean that I ll get free health insurance? A: N. The health care refrm law says that everyne must have cverage, but it des nt prvide free health insurance. Yu ll have different ptins fr getting health insurance, such as an emplyer plan, a private insurance plicy, r a plan ffered thrugh Cvered Califrnia. Mst peple will have t pay smething fr their cverage. Financial assistance may be available, but that is nly available fr certain lwer-incme individuals and their families wh qualify at Cvered Califrnia and whse emplyer des nt ffer a health plan that cmplies with the law. Q: Will I be able t stay n the Cunty f Kern medical plan? A: If yu are currently eligible t be n the Cunty plan, yu can keep yur current cverage. The Cunty will cntinue t ffer cverage t yu thrugh ur current medical prviders. All f ur plans meet and exceed the standards required by health care refrm. If yu are eligible fr health insurance with the Cunty but chse t pt ut, yu can purchase insurance thrugh Cvered Califrnia, but yu will nt be eligible fr a tax credit r premium assistance. Q: What if I d nt qualify fr Cunty f Kern medical benefits? A: If yu d nt qualify fr cverage under the Cunty plan, yu can buy yur health insurance directly frm an insurance cmpany/brker, r thrugh Cvered Califrnia. Open enrllment fr the marketplace begins Octber 1, 2013. Cverage will be effective January 1, 2014. Yu may be eligible fr a premium tax credit if yu purchase a qualified health plan thrugh Cvered Califrnia. Q: What is Cvered Califrnia? A: Cvered Califrnia is a shpping mall fr health insurance. It is an ptin that yu may use t cmpare varius health plans fr yu and yur family. It is als the nly place where yu might btain financial 21
assistance fr yur health premiums. Please visit www.cveredca.cm r call 1-(888) 975-1142 fr mre infrmatin. Q: Will I be required t have health insurance? A: As f January 1, 2014, everyne wh can affrd cverage (as determined by federal affrdability standards) will be required t purchase health insurance r pay a penalty. This rule is called the individual mandate. If the cst f a plan frm yur emplyer fr single cverage is greater than 9.5% f yur husehld incme fr the year, yu may be eligible fr a tax credit. Q: Hw much is the penalty fr nt having insurance? A: Fr an individual, the penalty will be $95 a year, r 1% f yur incme in 2014, whichever is greater. Fr a family, the penalty in 2014 will be the higher f $285 per year r 1% f husehld incme. The IRS will cllect the penalty thrugh tax returns. Beginning in 2014, federal returns will include a new line r frm t list yur surce f health insurance. Q: What is the better deal fr me, the Cunty plan r the marketplace? A: The Cunty cannt assist yu in evaluating yur ptins fr cverage, but yu can find mre infrmatin t help yu make yur decisin at www.healthcare.gv r www.cuidaddesalud.gv/es (Spanish); beginning Octber 1, yu can als call 1 (800) 318-2596. Please remember that if yu are eligible fr the Cunty s health plan, yu will nt be eligible fr a tax credit. Part B: Infrmatin Abut Health Cverage Offered by the Cunty f Kern Cunty f Kern (E.I.N. 95-6000925) 1115 Truxtun Avenue, 1st flr Bakersfield, CA 93301 1 (661) 868-3182 Fr Plan Benefits and Csts: http://www.kerncuntyhealthbenefits.cm Eligibility infrmatin, including qualifying dependents: http://www.kerncuntyhealthbenefits.cm/eligibility.aspx The Cunty f Kern ffers health plans t all permanent emplyees wrking at least 20 hurs a week, including cverage with respect t dependents. The plans we ffer all meet the minimum value standard, and the cst f this cverage is intended t be affrdable. We are sharing infrmatin with yu abut what is currently knwn r discussed abut health care refrm. We cannt guarantee its accuracy, r that there wn t be future changes, and many ther factrs can affect yu and yur ptins under the law. 22
STATE OF CALIFORNIA DEPARTMENT OF FAIR EMPLOYMENT AND HOUSING "NOTICE A" YOUR RIGHTS AND OBLIGATIONS AS A PREGNANT EMPLOYEE If yu are pregnant, have a related medical cnditin, r are recvering frm childbirth, PLEASE READ THIS NOTICE. Califrnia law prtects emplyees against discriminatin r harassment because f an emplyee s pregnancy, childbirth r any related medical cnditin (referred t belw as because f pregnancy ). Califrnia als law prhibits emplyers frm denying r interfering with an emplyee s pregnancy-related emplyment rights. Yur emplyer has an bligatin t: reasnably accmmdate yur medical needs related t pregnancy, childbirth r related cnditins (such as temprarily mdifying yur wrk duties, prviding yu with a stl r chair, r allwing mre frequent breaks); transfer yu t a less strenuus r hazardus psitin (where ne is available) r duties if medically needed because f yur pregnancy; and prvide yu with pregnancy disability leave (PDL) f up t fur mnths (the wrking days yu nrmally wuld wrk in ne-third f a year r 17⅓ weeks) and return yu t yur same jb when yu are n lnger disabled by yur pregnancy r, in certain instances, t a cmparable jb. Taking PDL, hwever, des nt prtect yu frm nnleave related emplyment actins, such as a layff. prvide a reasnable amunt f break time and use f a rm r ther lcatin in clse prximity t the emplyee's wrk area t express breast milk in private as set frth in Labr Cde sectin 1030, et seq. Fr pregnancy disability leave: PDL is nt fr an autmatic perid f time, but fr the perid f time that yu are disabled by pregnancy. Yur health care prvider determines hw much time yu will need. Once yur emplyer has been infrmed that yu need t take PDL, yur emplyer must guarantee in writing that yu can return t wrk in yur same psitin if yu request a written guarantee. Yur emplyer may require yu t submit written medical certificatin frm yur health care prvider substantiating the need fr yur leave. PDL may include, but is nt limited t, additinal r mre frequent breaks, time fr prenatal r pstnatal medical appintments, dctr-rdered bed rest, severe mrning sickness, gestatinal diabetes, pregnancy-induced hypertensin, preeclampsia, recvery frm childbirth r lss r end f pregnancy, and/r pstpartum depressin.
Ntice A YOUR RIGHTS AND OBLIGATIONS AS A PREGNANT EMPLOYEE Page 2 PDL des nt need t be taken all at nce but can be taken n an as-needed basis as required by yur health care prvider, including intermittent leave r a reduced wrk schedule, all f which cunts against yur fur mnth entitlement t leave. Yur leave will be paid r unpaid depending n yur emplyer s plicy fr ther medical leaves. Yu may als be eligible fr state disability insurance r Paid Family Leave (PFL), administered by the Califrnia Emplyment Develpment Department. At yur discretin, yu can use any vacatin r ther paid time ff during yur PDL. Yur emplyer may require r yu may chse t use any available sick leave during yur PDL. Yur emplyer is required t cntinue yur grup health cverage during yur PDL at the level and under the cnditins that cverage wuld have been prvided if yu had cntinued in emplyment cntinuusly fr the duratin f yur leave. Taking PDL may impact certain f yur benefits and yur senirity date; please cntact yur emplyer fr details. Ntice bligatins as an Emplyee: Give yur emplyer reasnable ntice: T receive reasnable accmmdatin, btain a transfer, r take PDL, yu must give yur emplyer sufficient ntice fr yur emplyer t make apprpriate plans 30 days advance ntice if the need fr the reasnable accmmdatin, transfer r PDL is freseeable, therwise as sn as practicable if the need is an emergency r unfreseeable. Prvide a Written Medical Certificatin frm Yur Health Care Prvider. Except in a medical emergency where there is n time t btain it, yur emplyer may require yu t supply a written medical certificatin frm yur health care prvider f the medical need fr yur reasnable accmmdatin, transfer r PDL. If the need is an emergency r unfreseeable, yu must prvide this certificatin within the time frame yur emplyer requests, unless it is nt practicable fr yu t d s under the circumstances despite yur diligent, gd faith effrts. Yur emplyer must prvide at least 15 calendar days fr yu t submit the certificatin. See yur emplyer fr a cpy f a medical certificatin frm t give t yur health care prvider t cmplete. PLEASE NOTE that if yu fail t give yur emplyer reasnable advance ntice r, if yur emplyer requires it, written medical certificatin f yur medical need, yur emplyer may be justified in delaying yur reasnable accmmdatin, transfer, r PDL. This ntice is a summary f yur rights and bligatins under the Fair Emplyment and Husing Act (FEHA). Fr mre infrmatin abut yur rights and bligatins as a pregnant emplyee, cntact yur emplyer, visit the Department f Fair Emplyment and Husing s Web site at www.dfeh.ca.gv, r cntact the Department at (800) 884-1684. The text f the FEHA and the regulatins interpreting it are available n the Department s Web site. ### DFEH-100-20 (11/12)
STATE OF CALIFORNIA DEPARTMENT OF FAIR EMPLOYMENT AND HOUSING NOTICE B FAMILY CARE AND MEDICAL LEAVE AND PREGNANCY DISABILITY LEAVE Under the Califrnia Family Rights Act f 1993 (CFRA), if yu have mre than 12 mnths f service with yur emplyer and have wrked at least 1,250 hurs in the 12-mnth perid befre the date yu want t begin yur leave, yu may have a right t an unpaid family care r medical leave (CFRA leave). This leave may be up t 12 wrkweeks in a 12-mnth perid fr the birth, adptin, r fster care placement f yur child r fr yur wn serius health cnditin r that f yur child, parent r spuse. Even if yu are nt eligible fr CFRA leave, if disabled by pregnancy, childbirth r related medical cnditins, yu are entitled t take pregnancy disability leave (PDL) f up t fur mnths, r the wrking days in ne-third f a year r 17⅓ weeks, depending n yur perid(s) f actual disability. Time ff needed fr prenatal r pstnatal care; dctrrdered bed rest; gestatinal diabetes; pregnancy-induced hypertensin; preeclampsia; childbirth; pstpartum depressin; lss r end f pregnancy; r recvery frm childbirth r lss r end f pregnancy wuld all be cvered by yur PDL. Yur emplyer als has an bligatin t reasnably accmmdate yur medical needs (such as allwing mre frequent breaks) and t transfer yu t a less strenuus r hazardus psitin if it is medically advisable because f yur pregnancy. If yu are CFRA-eligible, yu have certain rights t take BOTH PDL and a separate CFRA leave fr reasn f the birth f yur child. Bth leaves guarantee reinstatement t the same r a cmparable psitin at the end f the leave, subject t any defense allwed under the law. If pssible, yu must prvide at least 30 days advance ntice fr freseeable events (such as the expected birth f a child r a planned medical treatment fr yurself r a family member). Fr events that are unfreseeable, yu must t ntify yur emplyer, at least verbally, as sn as yu learn f the need fr the leave. Failure t cmply with these ntice rules is grunds fr, and may result in, deferral f the requested leave until yu cmply with this ntice plicy. Yur emplyer may require medical certificatin frm yur health care prvider befre allwing yu a leave fr: yur pregnancy; yur wn serius health cnditin; r t care fr yur child, parent, r spuse wh has a serius health cnditin. DFEH-100-21 (11/12)