Unified Fire Authority
Important Notices and Disclosures
Women ’ s Health and Cancer Rights Act
The Women ’ s Health and Cancer Rights Act of 1998 requires group health plans that provide medical and surgical coverage for mastectomies also provide coverage for reconstructive surgery following such mastectomies in a manner determined in consultation with the attending physician and the patient .
Coverage must include :
» All stages of reconstruction of the breast on which the mastectomy has been performed ,
» Surgery and reconstruction of the other breast to produce a symmetrical appearance , and
» Prostheses and treatment of physical complications of all stages of mastectomy , including lymphedema .
Benefits for the above coverage are payable on the same basis as any other physical condition covered under the plan , including any applicable deductible and / or copays and coinsurance amounts
Newborn ’ s Act Disclosure
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 insurance issuer for prescribing a length of stay not in excess of 48 hours ( or 96 hours ).
HIPAA Special Enrollment Rights
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 30 days after your or your dependents ’ other coverage ends ( or after the employer stops contributing toward the other coverage ).
You may also be able to enroll yourself or your dependents in the future if you or your dependents lose health coverage under Medicaid or your state Children ’ s Health Insurance Program , or become eligible for state premium assistance for purchasing coverage under a group health plan , provided that you request enrollment within 60 days after that coverage ends or after you become eligible for premium assistance .
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 yourself and your dependents . However , you must request enrollment within 30 days after the marriage , birth , adoption , or placement for adoption . To request special enrollment or obtain more information , contact your Human Resources Department . Refer to your benefit booklet for details
Qualified Medical Child Support Orders
Coverage will be provided to any of your dependent child ( ren ) if a Qualified Medical Child Support Order ( QMCSO ) is issued , regardless of whether the child ( ren ) currently reside with you . A QMCSO may be issued by a court of law or issued by a state agency as a National Medical Support Notice ( NMSN ), which is treated as a QMCSO . If a QMCSO is issued , the child or children shall become an alternate recipient treated as provisions , and procedures as all other plan participants .
Patient Protection Disclosure Notice
The Plan generally allows the designation of a primary care provider . You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members . For information on how to select a primary care provider , and for a list of the participating primary care providers , contact the medical carrier listed under “ Contacts ” in Guide .
For children , you may designate a pediatrician as the primary care provider .
You do not need prior authorization from the medical carrier or from any other person ( including a primary care provider ) in order to obtain access to obstetrical or gynecological care from a healthcare professional in our network who specializes in obstetrics or gynecology . The healthcare professional , however , may be required to comply with certain procedures , including obtaining prior authorization for certain services , following a preapproved treatment plan , or procedures for making referrals . For a list of participating healthcare professionals who specialize in obstetrics or gynecology , contact the medical carrier listed under “ Contacts ” in this Guide .
Preventive Care
Certain preventive care services must be provided by nongrandfathered group health plans without member cost-sharing ( such as deductibles or copays ) when these services are provided by a network provider . Please refer to your insurance company for more information . Contact information is listed under “ Contacts ” in this Guide .
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