Mental Health Parity Act –Per the Mental Health Parity Act, benefits for mental health and substance-use disorder must be treated like benefits for regular medical and surgical care. For example, if there is no limitation on the number of days for inpatient and number of visits for outpatient medical care, then there can be no limitation for mental health and substance-use disorder treatments. As always, treatments must be medically necessary to qualify for coverage.
Plan participants should review their plan’s certificate of coverage or benefit document for specific information about coverage, limitations and exclusions for mental health care and substance-use disorder treatments.
Women’s Health and Cancer Rights Act
On January 1, 1999, a federal law, the Women’s Health and Cancer Rights Act of 1998, became effective, which affects our company plan options. This law requires group health plans that provide coverage for mastectomies (ours does) and to also provide coverage for reconstructive surgery and prostheses following mastectomies. As required under the law, we have included this notice to inform you about it.
The law mandates that a participant or eligible beneficiary who is receiving benefits, on or after the law’s effective date (January 1, 1999, for our Plan), for a covered mastectomy and who elects breast reconstruction in connection with the mastectomy, will also receive coverage for:
- • All stages of reconstruction of the breast on which the mastectomy has been performed;
- • Surgery and reconstruction of the other breast to produce asymmetrical appearance and
- • Prostheses and treatment of physical complications of all stages of mastectomy, including lymphedemas.
This coverage will be provided in consultation with the patient and the patient’s attending physician and will be subject to the same annual deductible, coinsurance and/or co-payment provisions otherwise applicable under the Plan. If you have any questions about coverage for mastectomies and postoperative reconstructive surgery, please contact HR.
Summary of Benefits and Coverage (SBC)
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. To help you make an informed choice, the company makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about our health coverage in a standard format, to help you compare across options. The SBC also includes a Glossary of Health Coverage and Medical Terms to help you better understand health care terms used in the SBC. You can obtain a copy of the SBC at no cost to you by contacting HR.
Qualified life events include:
- Change in status: Marriage, divorce, legal separation, annulment or death• Change in number of dependents: Birth, death, adoption/placement for adoption or dependent reaching limiting age
- Change in employment status of employee, dependent or spouse that affects that individual’s eligibility
- Change in employee, spouse or dependent coverage on spouse’s plan during spouse’s Open Enrollment period * See Handbook for all qualified life events
It is your responsibility to notify Human Resources (HR) within 31 days of the event. If you fail to do so, you will not be able to enroll or make changes until the next Open Enrollment period. When you, your dependent(s) or your spouse become enrolled because of a qualified life event, coverage will be made effective retroactive to the date of the event. For more information, please contact HR. *In such cases you have 60 days to notify HR of the event instead of 31.
