Gloucester County Public Schools 2020-2021 New Hire Benefits Guide
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Gloucester County Public Schools 2020-2021 New Hire Benefits Guide
CONTENTS Medical & Pharmacy Coverage 4 Medical Plan Comparison 5 Virtual Care 6 Mobile App 6 Health Savings Account 7 Voluntary Benefits Program 8 Voluntary Dental 9 Vision 10 Employee Contributions in 2020 11 Employee Contributions in 2020 (cont.) 12 Flexible Spending Arrangements 13 Flexible Spending Arrangements, continued 14 Disability Income Benefits 15 Employee Assistance Program 16 Contact Information 17 Required Notices 18 2020 New Hire Benefits Guide -2-
WELCOME TO YOUR BENEFITS!
Our 2020-2021 Benefits Guide will provide you with an overview of the comprehensive and rewarding benefits
package offered by Gloucester County Public Schools. We value your contributions, as an employee and our
competitive benefits are one way that we thank you for all that you bring to Gloucester County Public Schools. We
are proud to offer you a benefits program designed to protect the health and financial security of you and your
family.
Benefits Eligibility
If you are a full-time employee, working 30 or more hours per week, and
have completed 30 days of service, you are eligible to enroll in the benefits WE ARE HERE TO HELP
described in this guide. Eligible dependents may enroll in medical, dental,
If you have any questions about
and vision coverage. Eligible dependents include:
the employee benefits described
Your legal spouse herein or would like more
information, please refer to your
Children up to age 26
plan documents and insurance
Unmarried children over age 26 who are incapable of self-support
booklets or contact:
How to Enroll
Budget & Finance Department
1. Evaluate plan options and make your benefit
elections on Employee Navigator. Lydia Gilbert (804) 693-7835
2. Submit elections through website. lydia.gilbert@gc.k12.va.us
https://www.employeenavigator.com/Benefits/
Login/Registration.aspx Laurie Greisz (804) 693-7817
Click on the green “Log In” button on the top right Laurie.greisz@gc.k12.va.us
corner, then select “Register as a New User”.
Complete the fields noted on the next page, using the Heather Lucas (804) 693-7811
Company Identifier – GCP-S01. Then click “Next”. Heather.lucas@gc.k12.va.us
Making Changes
Since your benefits paid via payroll deduction with pre-tax premiums, you can make a change during the year only if
you have a qualifying life event. The only exception to this rule is Open Enrollment. You must notify HR within 30
days of date of your qualifying event to make the change. If you do not make the change in the 30-day timeframe
consistent with the event, you will have to wait until the next annual open enrollment.
Examples of changes in status:
If you (and/or your dependents)
You get married or divorced
You experience a loss of other group coverage have Medicare or will become
You have a baby or adopt a child eligible for Medicare in the next
You or your spouse has a change in employment status 12 months, a Federal law gives
Your spouse dies you more choices about your
You become eligible for or lose Medicaid coverage
prescription drug coverage.
Please see page 29 for more
details.
2020 New Hire Benefits Guide -3-
MEDICAL & PHARMACY COVERAGE
Gloucester County School’s offers Cigna medical benefits. Benefits include
preventive care and prescription drug coverage. Under both plans, you have access
to Cigna’s national network. This is an overview of the benefits; refer to the medical
summary of benefits for complete details.
Plan Option 1
Key Terms Plan 25/30/1000 OAP Plus– This is an open access point of service plan that has a
$1,000 individual and $2,000 family plan year deductible. You are not required to
A premium is the pick a primary care physician and do not need referrals for specialist visits. In-
amount you pay out of network providers will charge flat copays for each of your visits, so costs are more
your paycheck for predictable for PCP and specialist visits.
insurance coverage
A deductible is the Plan Option 2
amount you pay before
the plan contributes to Choice Fund OAP HDHP w/ HSA – This is a high deductible health plan paired with
the cost for services a tax-advantaged health savings account (HSA). This option has the highest
A copay is a fixed deductible - $2,800 for individual and $5,600 for family; however, you can contribute
amount you pay for pre-tax funds to your HSA to help offset out-of-pocket costs. Gloucester County
medical services or Public Schools also contributes to your HSA. Employees will pay the lowest premium
prescription drugs for this option.
Coinsurance is the
percent of charges you
pay after you reach the Use the Employee Navigator comparison tool to
deductible until you
reach the plan’s out-of-
compare plan options based on your expected
pocket maximum medical expenses
The out-of-pocket
maximum is the most
you will pay during the
plan year for health
care expenses,
including your Find a Network Doctor
deductible, copays,
Visit www.mycigna.com for a list of
and coinsurance
In-Network doctors near you
2020 New Hire Benefits Guide -4-
MEDICAL PLAN COMPARISON
Choice Fund OAP HDHP with HSA
Plan 25/30/1000 OAP Plus
(Embedded)
In Network Benefits In Network In Network
Accumulators (Calendar Year
PY PY
or Plan Year)
Deductible (Ind/Fam) $1,000/$2,000 $2,800/$5,600
$5,500/$11,000 $4,000/$8,000
Out of Pocket Max (Ind/Fam)
All covered services except vision All covered services except vision
Embedded or Non Embedded Embedded Embedded
Coinsurance 30% 0%
Office Visit - (PCP/Specialist) $25 / $50 0% after the ded
Virtual Visit $25 copay $55 cost share, 0% after ded
Preventive Care Covered at 100% Covered at 100%
Urgent Care $50 copay 0% after the ded
Emergency Room 30% after the ded 0% after the ded
Inpatient Hospital 30% after the ded 0% after the ded
Outpatient Surgery 30% after the ded 0% after the ded
Included in OV copay; Independent
Labs/X-rays 0% after the ded
lab 30% after ded
Advanced Diagnostic Imaging 30% after the ded 0% after the ded
Chiropractic Care 30% after ded. Up to 30 visits 0% after the ded
Vision Exam – copay does not
apply towards the medical/RX out $15 copay $15 copay
of pocket
Out of Network Benefits
Deductible (Ind/Fam) $2,000/4,000 $2,800/$5,600
Out of Pocket Max (Ind/Fam) 50% 20%
Coinsurance $7,750/$15,500 $5,000/$10,000
Prescription Drug Benefits
Deductible (Ind/Fam) $250/$500 tiers 2-4 Subject to medical deductible
Retail 30-day (Tier 1/2/3/4) $15/$50/$90/20% to $200 max/rx $10/$30/$50/20% to $200 max/rx
Mail Order 90-day (Tier 1/2/3/4) $38/$125/$225/20% to $200 max/rx $25/$75/$125/20% to $200 max/rx
Disclosure: The above is a summary of benefits only. If there are any discrepancies, the certificate of coverage will prevail.
2020 New Hire Benefits Guide -5-VIRTUAL CARE
Cigna’s telemedicine benefit allows you to visit with local board-certified doctors online via video using your phone
or computer any time, from practically anywhere. Their national network is available 24/7, including holidays to
provide affordable quality care. Online physicians can diagnose, treat, and write prescriptions for routine medical
conditions. All you have to do is sign up online or download the free mobile app to get started.
www.MDLIVEforCigna.com www.AmwellforCigna.com
Toll free number: 888-726-3171 Toll free number: 855-667-9722
MOBILE APP
Whether you are traveling across the country, across the state, or just away from home, Cigna’s Mobile app keeps
your health information within reach, wherever you go.
With the mobile app, you can:
Find a Doctor
Get your ID card
Estimate your costs
Manage Prescription benefits
Access your health records
And more! Download the Mobile app today at www.cigna.com/individuals-families/member-resources/mobile-apps/!
It is available for iOS and Android devices!
Cigna Healthy Pregnancies, Healthy Babies
With the Cigna Healthy Pregnancies,
Healthy Babies Program you can work
with a maternity nurse in your 1st
trimester and post-partum and earn a
$150 gift card. Join in the 2nd trimester
and earn a $75 gift card.
2020 New Hire Benefits Guide -6-HEALTH SAVINGS ACCOUNT
If you enroll in the High Deductible Health Plan (Choice Fund OAP), you can also open a Health Savings Account
(HSA) to help pay for eligible medical expenses.
What is an HSA?
An HSA is a deposit account that you can use to pay for current and future qualified medical expenses – tax-
free. Money in your HSA earns interest and you have the option to invest funds.
Who is eligible to open an HSA?
To open an HSA, you must enroll in the HDHP plan. You cannot be a dependent on another person’s tax
return, be enrolled in Medicare if you’re over 65, or have received Veteran's Affairs benefits during the
previous 3 months, except for preventative care. If you are a veteran with a disability rating from the VA, this
exclusion does not apply.
What is the tax benefit associated with an HSA?
The money you contribute to your HSA is tax-deductible and is used for expenses for yourself and your
dependents. You can maximize your tax savings by contributing up to the maximum annual amount allowed
by the Internal Revenue Service (IRS). Your HSA balance plus investment earnings carry over from year to
year – tax-free.
Plus – your HSA funds are yours to keep – even if you switch health plans, change jobs, or retire.
Gloucester County Public Schools will contribute $100 per month ($1,200 a year) to your
HSA.
IRS HSA Contribution Maximum*
2020 2021
Individual $3,550 $3,600
Family $7,100 $7,200
Additional Additional
Catch-up – 55 or older
$1,000 $1,000
* Maximums include any employer contribution
What are qualified medical expenses?
The IRS maintains a list of all eligible medical expenses, common qualified expenses include:
Acupuncture Doctor’s fees
Ambulance services Hearing aids
Dental treatment Chiropractic Care
Contact lenses COBRA premiums
Effective 1/1/2020, the IRS now allows Over-the-Counter (OTC) medicines to be purchased with HSA
funds without a prescription.
View the complete list of qualified expenses at https://www.irs.gov/publications/p502/index.html
HSA Bank is the administrator of our HSA Benefits. See their website at www.hsabank.com.
2020 New Hire Benefits Guide -7-VOLUNTARY BENEFITS PROGRAM Gloucester County Public Schools knows that employees value the opportunity to customize their insurance coverage that meets individual needs. Aflac is the carrier for these plans. Please refer to the plan summaries in Employee Navigator for additional information. Voluntary Program 1 – Group Accident Insurance Accident Insurance can help protect you, your spouse or your children from the unexpected expense of an accident. Some of the common reasons for claims (cash benefits paid directly to you!) under an Accident benefit include broken bones, burns, and sports related injuries. Coverage is guarantee issue and includes portability with certain stipulations. This plan will include a $50 Wellness Rider! If you receive a wellness exam or health screening, you can receive a $50 wellness benefit by submitting proof of the exam or screening. This is limited to one per year. Examples include (but are not limited to) routine gynecological exams, general health exams, mammography, and certain blood tests. Voluntary Program 2 – Group Hospital Indemnity Insurance Hospital Indemnity Insurance provides cash benefits directly to you, unless otherwise assigned, that helps pay for medical and non-medical costs associated with a covered hospital stay due to a covered sickness or accidental injury. Coverage is available for employees, their spouses and dependent children. This is guarantee issue coverage and you can take this plan with you if you were to leave Gloucester County Public Schools (with certain stipulations). There is no pregnancy limitation and no pre-existing condition exclusions apply! This benefit will include a $50 Health Screening Benefit! If you receive a wellness exam or health screening, you can receive a $50 wellness benefit by submitting proof of the exam or screening. This is limited to one per year. Examples include (but are not limited to) routine gynecological exams, general health exams, mammography, and certain blood tests. Voluntary Program 3 – Group Critical Illness Insurance Critical Illness Insurance pays a lump sum benefit to you, unless otherwise assigned, upon diagnosis of one of the covered critical illnesses in the plan. Examples of these are cancer, heart attack, stroke, paralysis, and major organ failure. Coverage is also available for your spouse. Each dependent child is covered at 50 percent of the primary insured’s benefit amount at no additional charge. Children-only coverage is not available. This coverage comes with guaranteed issue amounts up to $30,000 for employees and $15,000 for spouses only at this initial enrollment. If you waive this year and choose to enroll in the future, you will be subject to medical questions. This benefit will include a $50 Health Screening Benefit! If you receive a wellness exam or health screening, you can receive a $50 wellness benefit by submitting proof of the exam or screening. This is limited to one per year. Examples include (but are not limited to) routine gynecological exams, general health exams, mammography, and certain blood tests. This benefit is not paid for dependent children. Accident, Critical Illness, and Hospital Indemnity Insurance are underwritten by Continental American Insurance Company (CAIC), a proud member of the Aflac family. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. This is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. These overviews are subject to the terms, conditions, and limitations of the Policy Forms C70100VA, C21100VA, and C80100VA. AGC1802565 IV (7/18) 2020 New Hire Benefits Guide -8-
VOLUNTARY DENTAL
Dental coverage is available through United Concordia. The plan allows you and your dependents to visit the in
network dentist of your choice. Preventive services are covered at 100% and other services are covered with
coinsurance. See an overview of the coverage below and view full details in your dental summary of benefits.
Dental Plan High Plan Low Plan
Deductible $50/$150 $50/150
Preventive Services
Exams, cleanings, x- Covered at 100% Covered at 100%
rays
Basic Services
Fillings, simple 20% 20%
extractions
Major Services
Oral surgery, root canal, 50% 0%
crowns
$2,000
Annual Maximum $2,000
(excludes orthodontics)
Waiting Periods None None
Orthodontic Services
50% No Coverage
(Adults & Children)
Orthodontic Lifetime
$2,000 (per Person) N/A
Max
Covered at 100% (Class I/Preventative Covered at 100% (Class I/Preventative
Services) Services)
Out of Network*
20% (Basic Services) 20% (Basic Services)
50% (Major Services) 100% (Major Services)
Coverage Adults and Children to age 26 (end of birthday year)
*Out-of-Network providers can balance bill you the difference between what they charge and the carrier’s reasonable
and customary amount.
Included Plan Features:
• Covers 1 additional cleaning during pregnancy
• Covers 1 additional periodontal maintenance
Pregnancy Benefit • Scaling and root planing
• 4 periodontal surgery procedures
• Covers 1 additional periodontal maintenance per
Smile for Health®--Wellness Provides periodontal care year and all are covered at 100%
for people with certain chronic medical conditions: • are covered at 100%
diabetes, heart disease, lupus, oral cancer, organ • 4 periodontal surgery procedures are covered at
transplant, rheumatoid arthritis and stroke 100% (scaling and root planning)
2020 New Hire Benefits Guide -9-VISION
Vision benefits are available through EyeMed. Our
vision plan covers eye exams and helps offset the Find an Eye Doctor
cost of corrective eyewear. An overview of the plan is
below; please see your summary of benefits for Visit www.eyemedvision.com for a list of
complete details. eye doctors near you
Out-of-Network Maximum
In-Network
Reimbursement
Eye Exam Copay $10 $40
Contact Lenses Standard Fitting Up to $55 N/A
$0 copay, $130 Allowance & 20%
Frames $91
off balance over allowance
Lenses
Single $25 Copay $30
Bifocal $25 Copay $50
Trifocal $25 Copay $70
Progressive (Standard) $90 Copay $50
Contact Lenses
$0 copay, $130 Allowance & 15%
Conventional $130
off balance over allowance
Medically Necessary $0 copay; Paid-in-full Up to $210
Frequency 12/12/12
2020 New Hire Benefits Guide - 10 -EMPLOYEE CONTRIBUTIONS IN 2020
Your premium for elected plans will be deducted pre-tax from each paycheck.
Medical Coverage
Plan 1
Plan 2*
Cigna OAP 25/30/1000
Choice Fund HDHP
15/50/90/20%
Employee Only $73.21 $55.00
Employee & Child(ren) $125.16 $105.00
Employee & Spouse $379.33 $335.11
Employee & Family $426.11 $362.15
Employee & Family (both)** $176.11 $112.15
*Employees enrolling in Choice Fund OAP HDHP will receive $100 monthly ($1,200 annually) into their individual
HSA account.
**Rates based on Employee and Spouse both qualifying as benefit eligible employees of Gloucester County Public
Schools.
Dental Coverage
Employee Monthly Premium
High Plan Low Plan
Employee Only $37.25 $20.97
Employee & 1 Dependent $65.33 $35.47
Employee & Family $103.79 $56.81
Vision Coverage
Employee Monthly Premium
Employee Only $6.02
Employee & Children $12.03
Employee & Spouse $11.43
Employee & Family $17.69
Tips for Keeping Costs Down:
Choose in-network providers
Take advantage of preventive care services
Request generic prescriptions
Use Urgent Care providers instead of the
Emergency Room
Try telemedicine for non-emergent health
consultations
2020 New Hire Benefits Guide - 11 -EMPLOYEE CONTRIBUTIONS IN 2020 (CONT.)
Aflac Group Accident Coverage Aflac Group Hospital Indemnity Coverage
Employee Monthly Post Tax Premium Employee Monthly Post Tax Premium
Accident Hospital Indemnity
Employee Only $16.10 Employee Only $22.44
Employee & Child(ren) $33.58 Employee & Child(ren) $34.54
Employee & Spouse $26.11 Employee & Spouse $42.82
Employee & Family $43.59 Employee & Family $54.92
Aflac Group Critical Illness Coverage (Uni-Tobacco Rates)
Employee Rates - Note if you have dependent children, they will automatically be covered for 50% of your benefit.
Employee Monthly POST TAX Premium
$10,000 $20,000 $30,000
18 - 25 $5.60 $9.68 $13.76
26 - 30 $7.27 $13.02 $18.78
31 - 35 $8.51 $15.50 $22.49
36 - 40 $11.03 $20.53 $30.04
41 - 45 $13.18 $24.83 $36.49
46 - 50 $15.63 $29.75 $43.86
51 - 55 $24.12 $46.72 $69.32
56 - 60 $23.78 $46.03 $68.29
61 - 65 $48.18 $94.84 $141.49
66+ $84.28 $167.05 $249.81
Spouse can elect up to 50% of the employee benefit.
$5,000 $10,000 $15,000
18-25 $3.56 $5.60 $7.64
26-30 $4.40 $7.27 $10.15
31-35 $5.02 $8.51 $12.01
36-40 $6.27 $11.03 $15.78
41-45 $7.35 $13.18 $19.01
46-50 $8.58 $15.63 $22.69
51-55 $12.82 $24.12 $35.42
56-60 $12.65 $23.78 $34.91
61-65 $24.85 $48.18 $71.51
66+ $42.90 $84.28 $125.66
2020 New Hire Benefits Guide - 12 -FLEXIBLE SPENDING ARRANGEMENTS
FSAs provide you with an important tax advantage that can help you pay for out-of-pocket medical, dental, vision,
and dependent care expenses on a pre-tax basis.
Contributions to your FSA deduct from your paycheck before any taxes. You should contribute the amount of money
you expect to spend on eligible expenses for the year. Per IRS ruling you may rollover up to $500 in your Health and
Limited FSA. Effective 1/1/2020, the IRS now allows Over-the-Counter (OTC) medicines to be purchased with
health care and limited FSA funds without a prescription.
Health Care FSA
The HealthCare FSA is for eligible medical, dental and vision
Health Care Tax Savings Example*
expenses. The maximum you can contribute to a health care Prescription drugs $225
FSA for 2020 is $2,750. The full amount you elect is available
at the beginning of the plan year. Examples of qualified Doctor co-pays $80
expenses include: Orthodontia (braces) $1,500
Prescriptions Dental care Suggested Plan Year Election $1,805
Doctor visit co-pays Copays & Coinsurance Taxes (30%) x 0.30
Contact lenses Estimated Annual Savings $541.50
Limited FSA
The Limited FSA is for those employees enrolled in the High Deductible Health Plan (Choice Fund OAP
HDHP/HSA). This FSA can only be used for eligible dental and vision expenses. The maximum you can
contribute to a Limited FSA for the 2020 plan year is $2,750. The full amount you elect is available at the beginning
of the plan year.
Dependent Care FSA
Dependent Care Tax Savings Example*
A Dependent Care FSA can be used to reimburse expenses
related to care of eligible dependents while you and your Day care for child $3,500
spouse work (dependent children under the age of 13 by a Summer child care $1,500
babysitter, day care or before/after-school care, disabled
spouse, parent or child (if individual lives with the covered Suggested Plan Year Election $5,000
employee). The maximum you can contribute to the Taxes (30%) x 0.30
dependent care FSA is $5,000 (or $2,500 if you are married
and filing separately). Funds are available only after they Estimated Annual Savings $1,500
deduct from your paycheck. This benefit is not eligible for *Tax savings examples are for illustrative purposes only
rollover. and not intended to reflect actual costs of care. 30% tax
rate is for illustration only and may be differ from your
rate.
Effective 1/1/2020, the IRS now allows Over-the-Counter
(OTC) medicines to be purchased with FSA funds without a prescription.
Full List of Qualified Expenses
The IRS maintains a complete list of qualified medical and dependent care expenses eligible for
FSA reimbursement. See the list at: https://www.irs.gov/publications/p502/index.html
2020 New Hire Benefits Guide - 13 -FLEXIBLE SPENDING ARRANGEMENTS, CONTINUED 2020 New Hire Benefits Guide - 14 -
DISABILITY INCOME BENEFITS
Gloucester County Public Schools is committed to providing a comprehensive benefits program. As part of your
benefits package, short-term disability coverage is provided to you at no cost. Long-term disability coverage is
available on a voluntary basis. Should you become unable to work due to a non-work related illness or injury,
disability coverage acts as income replacement to protect you and your family from serious financial hardship.
Short-Term Disability Coverage
Gloucester County Public Schools provides benefit eligible employees with short-term disability income benefits with
CIGNA. This is 100% employer paid. This program provides income protection for up to 24 weeks. Employees are
required to use all of their accumulated sick leave before becoming eligible for STD benefits. The elimination period
is the greater of the number of accumulated sick leave days or 15 days. Benefits are paid at 66-2/3% of regular
weekly compensation, up to $1,500 per week. Overtime, bonuses and any other form of extra pay are excluded
from the benefit calculation. The following exclusions apply: 1. Injury arising from employment; 2. Illness/Injury for
which employee is entitled to benefits under worker’s compensation; 3. Self-inflicted injury; 4. War or act of war; 5.
Injury from commission of a crime; 6. Disability while on active military duty; and 7. Disability which existed prior to
employment date. This plan will be available to members of the VRS Hybrid Plan only during the one year
waiting period for non-work related disability with the VRS
Short Term Disability CIGNA
Weekly Benefit Percentage 66.67%
Weekly Maximum $1,500
Benefits Begin for Accident 15th Day
Benefits Begin for Sickness 15th Day
Duration Maximum 26 Weeks
Voluntary Long-Term Disability Coverage
Gloucester County Public Schools provides all full-time, benefit-eligible employees the option to enroll in long term
disability income benefits with CIGNA. The employee pays 100% of the cost for this coverage through payroll
deductions. Hybrid VRS employees are only eligible for Option 1 coverage during the first year of Hybrid VRS
membership with GCPS. This eligibility ends when the employee is eligible for non-work related disability
through VRS. Employees will not be able to enroll on the Employee Navigator site. A paper application will
be required for NEW enrollments.
Long Term Disability Option 1 Option 2
Monthl y Benefit
50% 60%
Percentage
Monthl y Benefit Maximum $6,000 $6,000
Elimination Period 180 days 180 days
Benefit Duration 2 years SSNRA
Ow n Occupation Period 24 months 24 months
Under 35 $0.02 $0.08
35 - 39 $0.06 $0.12
40 - 44 $0.07 $0.19
45 - 49 $0.10 $0.30
50 - 54 $0.13 $0.45
55 + $0.18 $0.56
2020 New Hire Benefits Guide - 15 -EMPLOYEE ASSISTANCE PROGRAM
The Employee Assistance Program (EAP) offers confidential resources and referral services through Cigna. This
program no cost to you and provided by Gloucester County Public Schools.
The EAP assists you and your dependents on a variety of issues including:
Relationship counseling
Financial and legal counseling
Mental health counseling including depression and anxiety
Work/life balance resources
Family assistance including help finding childcare or elder care
Employees can take advantage of this resource with the full confidence that all information discussed with Cigna is
kept confidential.
You can access services by calling the toll free number or log onto their website.
Toll free number: 1(877) 622-4327
Website: www.cignabehavioral.com
Employer ID: Gloucester
LEGAL RESOURCES
Legal Resources® provides 100% coverage for you,
your spouse, and qualified dependents for the most
often needed legal services, protecting you and your
family from the high cost of attorney fees. Whether your
legal matter is for an everyday legal need or a result of
an unexpected life event, you will have immediate and
ongoing access to a network of top-rated law firms in
your area.
You pay no attorney fees for all Fully Covered Services,
which include will preparation, traffic court, advice and
consultation, real estate matters, divorce, billing
disputes, and more. The Legal Resources Plan covers
the employee, spouse, and dependent children to age
19 or full-time students to age 23 with unlimited use of
all services for $18.00 per month.
2020 New Hire Benefits Guide - 16 -CONTACT INFORMATION
Most questions or issues you may encounter can be resolved through the insurance carrier customer service
(phone numbers are on the back of your ID cards) and websites. The websites are designed for you to have
access to your entire plan and claims information, including information for any of your enrolled dependents.
It is simple for you to register and login to each of the sites. These sites have terrific interactive and
informational tools for you to get most of your questions answered. The websites include the following
information:
Claims Information – View expanded claims information and receive a report detailing your health
care expenditures.
Eligibility – See covered dependents under your plan and what benefits they are eligible for.
ID Cards – Request ID cards for you and your covered family members.
Provider Directory – Look up doctors and facilities to find participating providers.
Forms – Download and print necessary forms.
Benefit Provider Website Phone
Medical and Pharmacy Cigna www.mycigna.com 1-800-244-6224
Dental United Concordia www.unitedconcordia.com 1-800-972-4191 x 1
Vision EyeMed www.eyemed.com 1-866-939-3633
Flexible Spending
Flexible Benefit Administrators www.flex-admin.com 1-800-437-3539
Account
Short-Term Disability
Cigna www.cigna.com 1-800-244-6224
Long-Term Disability
Employee Assistance
Cigna Behavioral Health www.cignabehavioral.com 1-877–622-4327
Program
Health Savings
HSA Bank www.mycigna.com 1-800-244-6224
Accounts
Group Accident, Critical
Illness and Hospital Aflac www.aflacgroup.com 1-800-433-3036
Indemnity
Current Individual Aflac
Aflac www.aflac.com 1-800-992-3522
Products
The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by
the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit
information. While every effort was taken to accurately report your benefits, discrepancies or errors are always
possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will
prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If
you have any questions about your Guide, contact Human Resources.
2020 New Hire Benefits Guide - 17 -REQUIRED NOTICES
WOMEN’S HEALTH AND CANCER RIGHTS ACT
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 medical and surgical benefits
provided under this plan. Therefore, the Deductible and the Coinsurance applies.
If you would like more information on WHCRA benefits, call your Plan Administrator.
NEWBORNS’ AND MOTHERS HEALTH PROTECTION ACT ENROLLMENT NOTICE
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in
connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours
following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after
consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case,
plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a
length of stay not in excess of 48 hours (or 96 hours).
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 January 31, 2020. Contact your State for more information on eligibility –
2020 New Hire Benefits Guide - 18 -ALABAMA – Medicaid LOUISIANA – Medicaid
Website: http://myalhipp.com/ Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Phone: 1-855-692-5447 Phone: 1-888-695-2447
ALASKA – Medicaid MAINE – Medicaid
The AK Health Insurance Premium Payment Program Website: http://www.maine.gov/dhhs/ofi/public-
Website: http://myakhipp.com/ assistance/index.html
Phone: 1-866-251-4861 Phone: 1-800-442-6003
Email: CustomerService@MyAKHIPP.com TTY: Maine relay 711
Medicaid Eligibility:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS – Medicaid MASSACHUSETTS – Medicaid and CHIP
Website: http://myarhipp.com/ Website: http://www.mass.gov/eohhs/gov/departments/masshealth/
Phone: 1-855-MyARHIPP (855-692-7447) Phone: 1-800-862-4840
CALIFORNIA – Medicaid MINNESOTA – Medicaid
Website: Website:
https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.as https://mn.gov/dhs/people-we-serve/seniors/health-care/health-
px care-programs/programs-and-services/other-insurance.jsp
Phone: 1-800-541-5555 Phone: 1-800-657-3739
COLORADO – Health First Colorado (Colorado’s Medicaid
MISSOURI – Medicaid
Program) & Child Health Plan Plus (CHP+)
Health First Colorado Website: Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
https://www.healthfirstcolorado.com/ Phone: 573-751-2005
Health First Colorado Member Contact Center:
1-800-221-3943/ State Relay 711
CHP+: https://www.colorado.gov/pacific/hcpf/child-health-
plan-plus
CHP+ Customer Service: 1-800-359-1991/ State Relay 711
FLORIDA – Medicaid MONTANA – Medicaid
Website: http://flmedicaidtplrecovery.com/hipp/ Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-877-357-3268 Phone: 1-800-694-3084
GEORGIA – Medicaid NEBRASKA – Medicaid
Website: https://medicaid.georgia.gov/health- insurance- Website: http://www.ACCESSNebraska.ne.gov
premium-payment-program-hipp Phone: 678-564-1162 ext Phone: (855) 632-7633
2131 Lincoln: (402) 473-7000
Omaha: (402) 595-1178
INDIANA – Medicaid NEVADA – Medicaid
Healthy Indiana Plan for low-income adults 19-64 Medicaid Website: http://dhcfp.nv.gov
Website: http://www.in.gov/fssa/hip/ Medicaid Phone: 1-800-992-0900
Phone: 1-877-438-4479
All other Medicaid
Website: http://www.indianamedicaid.com
Phone 1-800-403-0864
IOWA – Medicaid NEW HAMPSHIRE – Medicaid
Website: http://dhs.iowa.gov/hawk-i Website: https://www.dhhs.nh.gov/oii/hipp.htm
Phone: 1-800-257-8563 Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-
3345, ext 5218
KANSAS – Medicaid NEW JERSEY – Medicaid and CHIP
Website: http://www.kdheks.gov/hcf/ Medicaid Website:
Phone: 1-785-296-3512 http://www.state.nj.us/humanservices/
dmahs/clients/medicaid/
Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710
KENTUCKY – Medicaid NEW YORK – Medicaid
Website: https://chfs.ky.gov Website: https://www.health.ny.gov/health_care/medicaid/
Phone: 1-800-635-2570 Phone: 1-800-541-2831
2020 New Hire Benefits Guide - 19 -NORTH CAROLINA – Medicaid TEXAS – Medicaid
Website: https://dma.ncdhhs.gov/ Website: http://gethipptexas.com/
Phone: 919-855-4100 Phone: 1-800-440-0493
NORTH DAKOTA – Medicaid UTAH – Medicaid and CHIP
Website: Medicaid Website: https://medicaid.utah.gov/
http://www.nd.gov/dhs/services/medicalserv/medicaid/ CHIP Website: http://health.utah.gov/chip
Phone: 1-844-854-4825 Phone: 1-877-543-7669
OKLAHOMA – Medicaid and CHIP VERMONT– Medicaid
Website: http://www.insureoklahoma.org Website: http://www.greenmountaincare.org/
Phone: 1-888-365-3742 Phone: 1-800-250-8427
OREGON – Medicaid and CHIP WASHINGTON – Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspx Website: https://www.hca.wa.gov/
http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-562-3022 ext.5473
Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid WEST VIRGINIA – Medicaid
Website: Website: http://mywvhipp.com/
http://www.dhs.pa.gov/provider/medicalassistance/healthinsura Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
ncepremiumpaymenthippprogram/index.htm
Phone: 1-800-692-7462
RHODE ISLAND – Medicaid and CHIP WISCONSIN – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ Website:
Phone: 855-697-4347, or 401-462-0311 (Direct Rite Share https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
Line) Phone: 1-800-362-3002
SOUTH CAROLINA – Medicaid WYOMING – Medicaid
Website: https://www.scdhhs.gov Website: https://health.wyo.gov/healthcarefin/medicaid/
Phone: 1-888-549-0820 Phone: 307-777-7531
SOUTH DAKOTA - Medicaid
Website: http://dss.sd.gov
Phone: 1-888-828-0059
VIRGINIA – Medicaid and CHIP
Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282
To see if any other states have added a premium assistance program since January 31, 2020, or for more information on special
enrollment rights, contact either:
U.S. Department of Labor U.S. Department of Health and Human Services
Employee Benefits Security Administration Centers for Medicare & Medicaid Services
www.dol.gov/agencies/ebsa www.cms.hhs.gov
1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of
information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes
that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays
a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a
currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be
subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid
OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent.
Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of
Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or
email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137. OMB Control Number 1210-0137 (expires 12/31/2019)
2020 New Hire Benefits Guide - 20 -IMPORTANT INFORMATION ABOUT YOUR COBRA CONTINUATION COVERAGE RIGHTS
Introduction
You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important
information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice
explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your
right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than
COBRA continuation coverage.
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 and other members of your family when group health coverage
would otherwise end. For more 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.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an
individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower
costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for
another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also
called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation
coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could
become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries
who elect COBRA continuation coverage are required to pay COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying
events:
Your hours of employment are reduced, or
Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the
following qualifying events:
Your spouse dies;
Your spouse’s hours of employment are reduced;
Your spouse’s employment ends for any reason other than his or her gross misconduct;
Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying
events:
The parent-employee dies;
The parent-employee’s hours of employment are reduced;
The parent-employee’s employment ends for any reason other than his or her gross misconduct;
The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
The parents become divorced or legally separated; or
The child stops being eligible for coverage under the Plan as a “dependent child.”
Sometimes, filing a proceeding in bankruptcy under Title 11 of the United States Code can be a qualifying event. If a proceeding in
bankruptcy is filed with respect to the Employer, and that bankruptcy results in the loss of coverage of any retired employee covered
under the plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and
dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the plan.
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a
qualifying event has occurred. The employer will notify the Plan Administrator of the following qualifying events:
The end of employment or reduction of hours of employment;
Death of the employee;
Commencement of a proceeding in bankruptcy with respect to the employer for retirees, or
The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
2020 New Hire Benefits Guide - 21 -For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for
coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must
provide this notice to: the plan administrator.
How is COBRA continuation coverage provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each
of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage.
Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation
coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment
termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage,
may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan
Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA
continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of
COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent
children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is
properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting
COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or
both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension
is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had
the first qualifying event not occurred.
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the
Health Insurance Marketplace, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage
options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than
COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends?
In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial
enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of
The month after your employment ends; or
The month after group health plan coverage based on current employment ends.
If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty
and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in
Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if
Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account
of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.
If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA
continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.
For more information visit https://www.medicare.gov/medicare-and-you.
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified
below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the
Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office
of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa.
2020 New Hire Benefits Guide - 22 -(Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information
about the Marketplace, visit www.HealthCare.gov.
Keep your Plan Administrator informed of address changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should
also keep a copy, for your records, of any notices you send to the Plan Administrator.
Please contact the Plan Administrator for additional information.
HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Gloucester County Public Schools sponsors certain group health plan(s) (collectively, the “Plan” or “We”) to provide benefits to our
employees, their dependents and other participants. We provide this coverage through various relationships with third parties that
establish networks of providers, coordinate your care, and process claims for reimbursement for the services that you receive. This
Notice of Privacy Practices (the “Notice”) describes the legal obligations of Gloucester County Public Schools, the Plan and your legal
rights regarding your protected health information held by the Plan under HIPAA. Among other things, this Notice describes how your
protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other
purposes that are permitted or required by law.
We are required to provide this Notice to you pursuant to HIPAA. The HIPAA Privacy Rule protects only certain medical information
known as “protected health information.” Generally, protected health information is individually identifiable health information, including
demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health
plan, or your employer on behalf of a group health plan, which relates to:
(1) your past, present or future physical or mental health or condition;
(2) the provision of health care to you; or
(3) the past, present or future payment for the provision of health care to you.
Note: If you are covered by one or more fully-insured group health plans offered by Gloucester County Public Schools, you will receive
a separate notice regarding the availability of a notice of privacy practices applicable to that coverage and how to obtain a copy of the
notice directly from the insurance carrier.
Contact Information
If you have any questions about this Notice or about our privacy practices, please contact the Gloucester County Public Schools HIPAA
Privacy Officer or:
Gloucester County Public Schools
Attention: HIPAA Privacy Officer
Contact: Payroll
Address: 6099 T.C. Walker Road Gloucester, VA 23061
Phone Number: 804-693-7811
Effective Date
This Notice as revised is effective August 1, 2020.
Our Responsibilities
We are required by law to:
maintain the privacy of your protected health information;
provide you with certain rights with respect to your protected health information;
provide you with a copy of this Notice of our legal duties and privacy practices with respect to your protected health
information; and
follow the terms of the Notice that is currently in effect.
We reserve the right to change the terms of this Notice and to make new provisions regarding your protected health information that we
maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised
Notice of Privacy Practices. You may also obtain a copy of the latest revised Notice by contacting our Privacy Officer at the contact
2020 New Hire Benefits Guide - 23 -information provided above. Except as provided within this Notice, we may not disclose your protected health information without your prior authorization. How We May Use and Disclose Your Protected Health Information Under the law, we may use or disclose your protected health information under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your protected health information. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose protected health information will fall within one of the categories. For Treatment We may use or disclose your protected health information to facilitate medical treatment or services by providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about your prior prescriptions to a pharmacist to determine if a pending prescription is inappropriate or dangerous for you to use. For Payment We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or precertification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments. For Health Care Operations We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud & abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. The Plan is prohibited from using or disclosing protected health information that is genetic information about an individual for underwriting purposes. To Business Associates We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, use and/or disclose your protected health information, but only after they agree in writing with us to implement appropriate safeguards regarding your protected health information. For example, we may disclose your protected health information to a Business Associate to administer claims or to provide support services, such as utilization management, pharmacy benefit management or subrogation, but only after the Business Associate enters into a Business Associate Agreement with us. As Required by Law We will disclose your protected health information when required to do so by federal, state or local law. For example, we may disclose your protected health information when required by national security laws or public health disclosure laws. To Avert a Serious Threat to Health or Safety We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your protected health information in a proceeding regarding the licensure of a physician. To Plan Sponsors For the purpose of administering the Plan, we may disclose to certain employees of the Employer protected health information. However, those employees will only use or disclose that information as necessary to perform Plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your protected health information cannot be used for employment purposes without your specific authorization. 2020 New Hire Benefits Guide - 24 -
You can also read
