Women s Health and Cancer Rights Act

Transcription

1 The following is a required annual notification: CATHOLIC CHARITIES BUREAU, INC. COMPREHENSIVE MAJOR MEDICAL HEALTH CARE PLAN AMENDMENT Women s Health and Cancer Rights Act Under the federal Women s Health and Cancer Rights Act of 1998, you are entitled to the following services: 1. reconstruction of the breast on which the mastectomy was performed; 2. surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. prosthesis and treatment for physical complications during all stages of mastectomy, including swelling of the lymph glands (lymphedema). Services are provided in a manner determined in consultation with the physician and patient. Coverage is provided on the same basis as any other illness. 5MN (11/12) V1.1.13

2 Important Notice From the Plan Administrator 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 the Claims Administrator and about your options under Medicare s prescription drug coverage. If 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. This information can help you decide whether or not you want to join a Medicare drug plan. Information 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 prescription 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. The Claims Administrator has determined that the prescription drug coverage offered through your employer 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 on average, at least as good as standard Medicare prescription drug 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 Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th to December 7 th. However, if you lose creditable prescription drug coverage through no fault of your own, you will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. 2

3 What Happens To Your Current Coverage If You Decide To Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current coverage will not be affected. You may keep your current coverage with the Claims Administrator and this Plan will coordinate with your Medicare drug plan. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents might not be able to get this coverage back. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage and do not 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. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1 percent of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without creditable coverage, your premium may consistently be at least 19 percent 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. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage Contact Customer Service at the telephone number provided in the Customer Service section. NOTE: You will receive this notice each year. You will also receive it before the next period you can join a Medicare drug plan and if this coverage through the Claims Administrator changes. You may request a copy of this notice anytime. For More Information 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 will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. 3

4 For more information about Medicare prescription drug coverage: Visit Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call MEDICARE ( ). TTY users should call If 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. If 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 you are required to pay a higher premium (a penalty). 4

5 The following changes are hereby made effective January 1, 2013: In the SPECIAL FEATURES section, the following is hereby added: Online Health Assessment and Online Health Coaching Programs The Online Health Assessment and Online Health Coaching Programs are available to you at ccstpa.com or the member center at the Claims Administrator s website. Taking the Online Health Assessment is your first step to a healthier lifestyle. Answer questions about your health history, nutrition, physical activity, and more. You will instantly get a report just for you. It takes just 20 minutes and is completely confidential. Then take advantage of the Online Coaching Courses focused on fitness, nutrition, weight loss, reducing stress, and more. Each program includes an action plan and tips for success to keep you on track. In the NOTIFICATION REQUIREMENTS section, in the item titled Prior Authorization the ninth bullet is hereby deleted. In the BENEFIT CHART section, in the item titled Hospice Care under NOTES the first and second bullets are hereby deleted. In the BENEFIT CHART section, in the item titled Medical Equipment, Prosthetics, and Supplies under NOT COVERED the following exclusion is hereby added: scalp/cranial hair prosthesis (wigs), except as specified in the Benefit Chart In the BENEFIT CHART section, in the item titled Prescription Drugs and Insulin under The Plan Covers the following bullet is hereby added: Retail Pharmacy Vaccine Program 100% when you present your ID card or otherwise provide notice of coverage at the time of purchase. NO COVERAGE. In the BENEFIT CHART section, in the item titled Prescription Drugs and Insulin under NOTES the following bullet is hereby added: The Retail Pharmacy Vaccine program allows you the opportunity to receive certain eligible vaccines at designated pharmacies. This program is in addition to your current vaccine benefit administered through your clinic/physician s office. A list of eligible vaccines under this program and designated pharmacies are available on the Claims Administrator s website or by contacting Customer Service. In the BENEFIT CHART section, in the item titled Preventive Care under NOTES the following bullet is hereby added: Certain vaccines are also covered under the retail pharmacy vaccine program. Refer to Prescription Drugs and Insulin. In the BENEFIT CHART section, in the item titled Preventive Care under NOTES the third bullet is hereby deleted and replaced with the following: Services to treat an illness/injury diagnosed as a result of preventive care services may be covered under other Plan benefits. Refer to Hospital Inpatient, Hospital Outpatient, and Physician Services. 5

6 In the BENEFIT CHART section, in the item titled Preventive Care under NOT COVERED the following bullets are hereby added: services for or related to surgical implants for elective female sterilization services for or related to prescription contraceptive drugs and supplies In the GENERAL EXCLUSIONS section, the following exclusion is hereby added: Scalp/cranial hair prosthesis (wigs), except as specified in the Benefit Chart. In the GENERAL EXCLUSIONS section, exclusion number 25 is hereby deleted and replaced with the following: 25. Services for or related to therapeutic support of foster care (services designed to enable the foster family to provide a therapeutic family environment or support for the foster child's improved functioning); treatment of learning disabilities, except when medically necessary and provided by an eligible health care provider; therapeutic day care and therapeutic camp services; and hippotherapy (equine movement therapy). In the GENERAL PROVISIONS section, under Important Plan Information the item titled Plan Year is hereby deleted and replaced with the following: ERISA Plan Year: January 1 st through December 31 st 6