34 | 2023 EMPLOYEE BENEFITS GUIDE
Legal Notices
Availability of Summary Health Information
As an employee, the health benefits available to you represent a significant component
of your compensation package. They also provide important protection for you and
your family in the case of illness or injury.
You will receive a Summary of Benefits and Coverage (SBC) during Open Enrollment
period. These documents summarize important information about all health coverage
options in a standard format. Please contact Human Resources if you have any
questions or did not receive your SBC.
COBRA Continuation Coverage Rights
The right to COBRA continuation coverage was created by a federal law, the Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can
become available to you when you would otherwise lose your group health coverage. It
can also become available to other members of your family who are covered under the
Plan when they would otherwise lose their group health coverage. For additional
information about your rights and obligations under the Plan and under federal law, you
should review the Plan’s Summary Plan Description or contact the Plan Administrator.
HIPAA/CHIP Special Enrollment Notice
Loss of other Coverage (excluding Medicaid or a State Children’s Health Insurance
Program). If you decline enrollment for 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 Company stops contributing
toward your or your dependents’ other coverage). However, 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 for Medicaid or a State Children’s Health Insurance Program. If
you decline enrollment for 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 ends 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 after the marriage, birth, adoption, or
placement for adoption. If you request a change due to a special enrollment event
within the applicable 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.
Eligibility for Medicaid or a State Children’s Health Insurance Program. If you or
your dependents (including your spouse) become eligible for a state premium
assistance subsidy from Medicaid or through 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.
To request special enrollment or obtain more information, contact Human Resources
Newborns’ and Mothers’ Notice
Under federal law, group health plans and health insurance issuers offering group health
insurance generally may not restrict benefits for any hospital length of stay in
connection with childbirth for the mother or the newborn child to less than 48 hours
following a vaginal delivery, or less than 96 hours following a cesarean section.
However, the plan or issuer may pay for a shorter stay if the attending physician (e.g.,
your physician, nurse, [or midwife], or a physician assistant), after consultation with the
mother, discharges the mother or newborn earlier.
Also, under federal law, plans and insurers may not set the level of benefits or out-of-
pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a
manner less favorable to the mother or newborn than any earlier portion of the stay.
In addition, a plan or issuer may not, under federal law, require that a physician or other
health care provider obtain authorization for prescribing a length of stay of up to 48
hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-
of-pocket costs, you may be required to obtain precertification. For information on
precertification, contact your plan administrator.
Women's Health and Cancer Rights Act Notice
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.
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
www.healthcare.gov.
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 1-877-KIDS NOW or www.insurekidsnow.gov 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 determined
eligible for premium assistance. If you have questions about enrolling in your employer
plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-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 July 31, 2022.
Contact your State for more information on eligibility –