Legal Notices
The Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) require certain information related to health benefit plans be issued to employees in writing. These notices explain your rights and obligations in relation to the health plan provided by your employer. Please note this is not a legal document and should not be construed as legal advice.
The following is a summary of notices included in this packet:
• COBRA Rights
• Family Medical Leave Act
• Qualified Medical Child Support Order
• HIPAA Privacy Notice
• HIPAA Special Enrollment Right
• Newborn and Mother’s Health Protection Act
• Women’s Health and Cancer Rights Act
• Genetic Information Nondiscrimination Act
• Marketplace Exchange Notice
• Medicaid and Child Health Insurance
• Medicare Part D Notice
CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA)
The Consolidated Omnibus Budget Reconciliation Act gives workers and their families who lose their health benefits the right to choose to continue group health benefits for limited periods of time under certain circumstances, such as, voluntary or involuntary job loss, reduction in the hours worked, death, divorce, and other events. Qualified individuals may be required to pay the entire cost for coverage up to 102% of the cost for the Plan.
FAMILY MEDICAL LEAVE ACT (FMLA)
The Family Medical Leave Act entitles eligible employees of covered employers to take unpaid, job-protected leave due to a serious health condition for the employee or immediate family. To be eligible, the employee must have worked at least 1,250 hours during the prior 12 consecutive months. For additional details, visit the Department of Labor FMLA page. Notify your employer when you have a qualifying event, such as, birth or adoption of a child, a serious health condition, need to care for a spouse, child or parent with a serious medical condition, or for reservist or National Guard provisions related to you or an immediate family member leaving for military duty or being injured in active duty.
QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO)
A qualified medical child support order is issued under state law that creates or recognizes the existence of an “alternate recipient’s” right to receive benefits. An “alternate recipient” is any child of an employee or spouse (including a child adopted by or placed for adoption) who is recognized under a medical child support order as having a right to enrollment under a group health plan. Upon receipt, the employer is required to determine within a reasonable period of time, whether a medical child sup-port order is qualified, and to administer benefits in accordance with the applicable terms of each qualified order. In the event you are served with a notice to provide medical coverage for a dependent child as the result of a legal determination, you may obtain information from your employer. Like most other pre-scribed timelines for enrolling under this provision, you must provide a completed application for enrollment for the alternate recipient within 30 days of the court order.
HIPAA PRIVACY NOTICE
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires health plans to comply with privacy rules. These rules are intended to protect your personal health information (PHI) from being inappropriately disclosed. They also give you additional rights concerning your healthcare information. The HIPAA Privacy Notice explains how the group health plan and your employer handles your PHI. You can request a copy of this Notice from the Human Resources Department.
HIPAA SPECIAL ENROLLMENT NOTICE
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, 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 employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 31 days after the other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll your dependents. However, you must request enrollment within 31 days of the event.
Special enrollment rights also may exist in the following circumstances:
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If you or your dependents experience a loss of eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP) coverage and you request enrollment within 60 days after that coverage ends; or
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If you or your dependents become eligible for a state premium assistance subsidy through Medicaid or a state CHIP with respect to coverage under this plan and you request enrollment within 60 days after the determination of eligibility for such assistance.
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Note: The 60-day period for requesting enrollment applies only to state CHIP and/or Medicaid. As described above, a 31-day period applies to most special enrollments.
If you have a Qualifying Status change during the year, contact your Human Resources Department immediately. Changes becomes effective on the first of the month following the event and the approval of the change (except for birth or adoption of a child(ren), which are covered retroactive to the date of the event).
To request special enrollment or obtain more information, contact your Human Resources Department.
WOMEN’S HEALTH & 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:
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All stages of reconstruction of the breast on which the mastectomy was performed;
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Surgery and reconstruction of the other breast to produce symmetrical appearance;
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Prostheses; and
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Treatment of physical complications of the mastectomy, including lymph edema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator.
NEWBORN AND MOTHER’S HEALTH PROTECTION ACT
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 physician, 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 insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
GENETIC INFORMATION NON-DISCRIMINATION ACT (GINA)
The Genetic Information Nondiscrimination Act is designed to prohibit the use of genetic information in health insurance and employment. The Act prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future.
The legislation also bars employers from using individual’s genetic information when making hiring, firing, job placement or promotion decision.
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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 are 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 pro-grams. If you or your children are not eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance pro-grams but you may be able to buy individual insurance cover-age 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, you can contact your state Medicaid of CHIP office, call 1-877-KIDSNOW or you can visit 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.
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 cover-age 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).
Arizona CHIP website: www.azahcccs.gov/applicants
Arizona CHIP telephone:
1-877-764-5437 - Outside Maricopa County
602-417-5437 - Maricopa County
To see if any other states have added a premium assistance program since January 31, 2017, or for more information on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
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U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
1-877-267-2323, Menu Option 4, Ext. 61565
MEDICARE PART D
The prescription benefit under the PPO Copay plan is deemed creditable.
The prescription benefit under the HDHP/HSA plan is deemed creditable.
MARKETPLACE EXCHANGE NOTICE
Beginning in 2014, there was a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.
The 2024 open enrollment period for health insurance coverage through the Marketplace is available Nov. 1, 2023, through Jan. 31, 2024. Individuals must have enrolled or changed plans prior to Dec. 15, 2023, for coverage starting as early as Jan. 1, 2024. After Jan. 31, 2024, you can get coverage through the Marketplace for 2024 only if you qualify for a special enrollment period or are applying for Medicaid or the Children’s Health Insurance Program (CHIP).
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Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium or a reduction in certain cost-sharing if your employer does not offer cover-age to you at all or does not offer coverage that meets certain standards.
If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5 percent (as adjusted each year after 2014) of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. (An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.)
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution as well as your employee contribution to employer-offered coverages often excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or contact Human Resources Department.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Market-place and its costs. Please visit HealthCare.gov for more information, as well as an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
Employer name
Navajo County
EIN
86-6000541
Employer address
100 East Code Talkers Drive,
PO Box 668
Holbrook, AZ 86025
Employer phone
Who can we contact about employee health coverage at this job?
Name: Eric Scott
Email: eric.scott@navajocountyaz.gov
Phone: 928-524-4033