Page 58 - SIH 2022 Re-Enrollment Guide
P. 58
FEDERALLY REQUIRED NOTICES
Notice of Creditable Coverage Remember: Keep this Creditable Coverage notice.
Prescription Drug Information for SIH If you decide to join one of the Medicare drug
plans, you may be required to provide a copy of this
Plan Participants notice when you join to show whether or not you
This Notice conirms that the SIH Group Health have maintained creditable coverage and whether
Insurance is Creditable Coverage. This means that or not you are required to pay a higher premium (a
the prescription coverage ofered through SIH is, penalty).
on average, as good as or better than the standard
Medicare prescription drug coverage (Medicare Part Women’s Health and Cancer
D). You can keep your existing group prescription Rights Notice
coverage and choose not to enroll in a Medicare
Part D plan. SIH Employee Health Care Plan is required by law to
provide you with the following notice:
Because your existing coverage is Creditable
Coverage, you will not be penalized if you later The Women’s Health and Cancer Rights Act of
decide to enroll in a Medicare prescription drug 1998 (“WHCRA”) provides certain protections for
plan. However, you must remember that if you individuals receiving mastectomy-related beneits.
drop your coverage through SIH and experience Coverage will be provided in a manner determined
a continuous period of 63 days or longer without in consultation with the attending physician and the
Creditable Coverage, you may be penalized if you patient for:
enroll in a Medicare Part D plan later. If you choose X All stages of reconstruction of the breast on
to drop your SIH coverage, the Medicare Special which the mastectomy was performed;
Enrollment Period for enrollment into a Medicare
Part D plan is two months after your SIH coverage X Surgery and reconstruction of the other breast
ends. to produce a symmetrical appearance;
X Prostheses; and
If you keep your existing group coverage through X Treatment of physical complications of the
SIH, it is not necessary to join a Medicare mastectomy, including lymphedemas.
prescription drug plan this year. Plan participants
who decide to enroll in a Medicare prescription The SIH Health Beneit Plans provide(s) medical
drug plan may need to provide a copy of the Notice coverage for mastectomies and the related
of Creditable Coverage to enroll in the Medicare procedures listed above, subject to the same
prescription plan without a inancial penalty. deductibles and coinsurance applicable to other
medical and surgical beneits provided under this
For more information about Medicare prescription plan.
drug coverage:
If you would like more information on WHCRA
X Visit www.medicare.gov beneits, please refer to your Summary Plan
X Call 1.800-MEDICARE (1.800.633.4227). TTY Description or contact your Plan Administrator at
users should call 1.877.486.2048. 618.457.5200.
58
Notice of Creditable Coverage Remember: Keep this Creditable Coverage notice.
Prescription Drug Information for SIH If you decide to join one of the Medicare drug
plans, you may be required to provide a copy of this
Plan Participants notice when you join to show whether or not you
This Notice conirms that the SIH Group Health have maintained creditable coverage and whether
Insurance is Creditable Coverage. This means that or not you are required to pay a higher premium (a
the prescription coverage ofered through SIH is, penalty).
on average, as good as or better than the standard
Medicare prescription drug coverage (Medicare Part Women’s Health and Cancer
D). You can keep your existing group prescription Rights Notice
coverage and choose not to enroll in a Medicare
Part D plan. SIH Employee Health Care Plan is required by law to
provide you with the following notice:
Because your existing coverage is Creditable
Coverage, you will not be penalized if you later The Women’s Health and Cancer Rights Act of
decide to enroll in a Medicare prescription drug 1998 (“WHCRA”) provides certain protections for
plan. However, you must remember that if you individuals receiving mastectomy-related beneits.
drop your coverage through SIH and experience Coverage will be provided in a manner determined
a continuous period of 63 days or longer without in consultation with the attending physician and the
Creditable Coverage, you may be penalized if you patient for:
enroll in a Medicare Part D plan later. If you choose X All stages of reconstruction of the breast on
to drop your SIH coverage, the Medicare Special which the mastectomy was performed;
Enrollment Period for enrollment into a Medicare
Part D plan is two months after your SIH coverage X Surgery and reconstruction of the other breast
ends. to produce a symmetrical appearance;
X Prostheses; and
If you keep your existing group coverage through X Treatment of physical complications of the
SIH, it is not necessary to join a Medicare mastectomy, including lymphedemas.
prescription drug plan this year. Plan participants
who decide to enroll in a Medicare prescription The SIH Health Beneit Plans provide(s) medical
drug plan may need to provide a copy of the Notice coverage for mastectomies and the related
of Creditable Coverage to enroll in the Medicare procedures listed above, subject to the same
prescription plan without a inancial penalty. deductibles and coinsurance applicable to other
medical and surgical beneits provided under this
For more information about Medicare prescription plan.
drug coverage:
If you would like more information on WHCRA
X Visit www.medicare.gov beneits, please refer to your Summary Plan
X Call 1.800-MEDICARE (1.800.633.4227). TTY Description or contact your Plan Administrator at
users should call 1.877.486.2048. 618.457.5200.
58
