Important Notices and Disclosures
To see if any other states have added a premium assistance program since January 31 , 2024 , or for more information on special enrollment rights , contact either :
U . S . Department of Labor Employee Benefits Security Administration www . dol . gov / agencies / ebsa
U . S . Department of Health and Human Services Centers for Medicare & Medicaid Services 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 .
HIPAA Special Enrollment Rights Protecting Your Health Information Privacy Rights
OMB Control Number 1210-0137 ( expires 1 / 31 / 2026 )
Davis Behavioral Health is committed to the privacy of your health information . The administrators of the Davis Behavioral Health Plan ( the “ Plan ”) use strict privacy standards to protect your health information from unauthorized use or disclosure .
The Plan ’ s policies protecting your privacy rights and your rights under the law are described in the Plan ’ s Notice of Privacy Practices . You may receive a copy of the Notice of Privacy Practices by contacting Kathi Hanson - Human Resources at 801.336.1845 or kathih @ dbhutah . org .
Davis Behavioral Health
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