Notice of Your HIPAA Special Enrollment Rights
Loss of Other Coverage - If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage or group health plan coverage, you may be able to enroll yourself and/or your dependents in this plan if you or your dependents lose eligibility for that other coverage or if the employer stops contributing towards your or your dependent’s coverage. To be eligible for this special enrollment opportunity you must request enrollment within 30 days after your other coverage ends or after the employer stops contributing towards the other coverage. For more information, please click here.
Medicaid and the Children’s Health Insurance Programs (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families- If 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 CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
• If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on the notice below, you can 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, you can 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, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.
For more information and a copy of the complete notice, please click here.
The Newborns’ and Mothers’ Health Protection Act- Federal law generally prohibits restricting benefits for hospital lengths of stay to less than 48 hours following a vaginal delivery and less than 96 hours following a caesarean section. However, the plan may pay for a shorter stay if the attending provider (physician, nurse midwife or physician assistant) discharges the mother or newborn earlier, after consulting with the mother.
Also, federal law states that plan benefits may not, for the purpose of benefits or out-of-pocket costs, treat the later portion of a hospital stay in a manner less favorable to the mother or newborn than any earlier portion of the stay.
Finally, federal law states that a plan may not require a physician or other health care provider to obtain authorization of a length of stay up to 48 hours or 96 hours, as described above. However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain precertification.
The Women’s Health and Cancer Rights Act - In accordance with the Women’s Health and Cancer Rights Act, this Plan covers the follow procedures for a person receiving benefits for an appropriate mastectomy:
• Reconstruction of the breast on which a mastectomy has been performed;
• Surgery and reconstruction of the other breast to create a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of all stages of mastectomy, including lymphedemas.
This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions that apply to the mastectomy. For answers to questions about the plan’s coverage of mastectomies and reconstructive surgery, call Aetna’s Member Services at the number shown on your ID card.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985)- If you lose your job, employers subject to COBRA must offer you and any family members covered by your group health plan (qualified beneficiaries) the opportunity to purchase the insurance coverage. For more information on COBRA, please click here. For a copy of the SNJREBF COBRA Notice of Rights, please click here.
New Jersey Chapter 375 - Dependent Coverage to Age 31 - The State of New Jersey has enacted legislation that extends eligibility for medical and prescription drug coverage for certain dependents. Under this regulation, your dependent may be eligible to maintain coverage under your benefit plan to their 31st birthday. Your dependent may be eligible for these extended benefits (called "Chapter 375 Dependent" benefits). For more information on NJ Chapter 375 Dependent Coverage to Age 31, please click here.
Notice of Creditable Coverage- The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. Accordingly, this information is essential to an individual's decision whether to enroll in a Medicare. For a copy of the notice- Notice of Creditable Coverage
SNJREBF Notice of Privacy Practices- The Southern New Jersey Regional Employee Benefits Fund (the “Plan”) respects the confidentiality of your personal health information. The Plan is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information. This notice describes how the Plan may use or disclose your protected health information and your rights to access and amend your protected health information. For a copy of this notice, please click here.
Please remember your insurance benefits are limited to the terms, conditions, exclusions and limitations of the insurance carrier's policy. Nothing contained on this website shall be deemed to have altered, waived, or extended the coverage provided by the policy. This overview contains a general information regarding your benefit plans for your use as a convenient reference. Complete details of your program appear in the policy, which govern the benefits and operation of your program. The policy supersedes if there should be any inconsistency or difference between its provisions and the information in this overview. |
