Page 9 - Nortek Legal Notices
P. 9
Nortek
Organized Health Care Arrangement Designation If the event giving rise to your
The Plan participates in what the federal privacy rules call an “Organized Health Care special enrollment right is a loss of
Arrangement .” The purpose of that participation is that it allows PHI to be shared between coverage under Medicaid or CHIP,
the members of the Arrangement, without authorization by the persons whose PHI is you may request enrollment under
shared, for health care operations . Primarily, the designation is useful to the Plan because this plan within 60 days of the date
it allows the insurers who participate in the Arrangement to share PHI with the Plan for you or your dependent(s) lose such
purposes such as shopping for other insurance bids . coverage under Medicaid or CHIP .
Similarly, if you or your dependent(s)
The members of the Organized Health Care Arrangement are: become eligible for a state-granted
premium subsidy toward this plan,
Nortek Medical Plan you may request enrollment under
Nortek Dental Care Plan this plan within 60 days after the
Nortek Vision Plan date Medicaid or CHIP determine that
Nortek Flexible Beneits Plan you or the dependent(s) qualify for
Effective Date: the effective date of this Notice is: April 15, 2013 . the subsidy .
In addition, if you have a new
Nortek Employee Health Care Plan dependent as a result of marriage,
Notice of Special Enrollment Rights birth, adoption, or placement for
If you are declining enrollment for yourself or your dependents (including your spouse) adoption, you may be able to enroll
yourself and your dependents .
because of other health insurance or group health plan coverage, you may be able to later However, you must request
enroll yourself and your dependents in this plan if you or your dependents lose eligibility enrollment within 30 days after
for that other coverage (or if the employer stops contributing toward your or your the marriage, birth, adoption, or
dependents’ other coverage) .
placement for adoption .
Loss of eligibility includes but is not limited to: To request special enrollment or
X Loss of eligibility for coverage as a result of ceasing to meet the plan’s eligibility obtain more information, contact
requirements (i .e ., legal separation, divorce, cessation of dependent status, death your local Human Resources
of an employee, termination of employment, reduction in the number of hours of representative .
employment); * This notice is relevant for healthcare
X Loss of HMO coverage because the person no longer resides or works in the HMO coverages subject to the HIPAA
service area and no other coverage option is available through the HMO plan sponsor; portability rules
X Elimination of the coverage option a person was enrolled in, and another option is not
offered in its place;
X Failing to return from an FMLA leave of absence; and
X Loss of coverage under Medicaid or the Children’s Health Insurance Program (CHIP) .
Unless the event giving rise to your special enrollment right is a loss of coverage under
Medicaid or CHIP, you must request enrollment within 30 days after your or your
dependent’s(s’) other coverage ends (or after the employer that sponsors that coverage
stops contributing toward the coverage) .
9
Organized Health Care Arrangement Designation If the event giving rise to your
The Plan participates in what the federal privacy rules call an “Organized Health Care special enrollment right is a loss of
Arrangement .” The purpose of that participation is that it allows PHI to be shared between coverage under Medicaid or CHIP,
the members of the Arrangement, without authorization by the persons whose PHI is you may request enrollment under
shared, for health care operations . Primarily, the designation is useful to the Plan because this plan within 60 days of the date
it allows the insurers who participate in the Arrangement to share PHI with the Plan for you or your dependent(s) lose such
purposes such as shopping for other insurance bids . coverage under Medicaid or CHIP .
Similarly, if you or your dependent(s)
The members of the Organized Health Care Arrangement are: become eligible for a state-granted
premium subsidy toward this plan,
Nortek Medical Plan you may request enrollment under
Nortek Dental Care Plan this plan within 60 days after the
Nortek Vision Plan date Medicaid or CHIP determine that
Nortek Flexible Beneits Plan you or the dependent(s) qualify for
Effective Date: the effective date of this Notice is: April 15, 2013 . the subsidy .
In addition, if you have a new
Nortek Employee Health Care Plan dependent as a result of marriage,
Notice of Special Enrollment Rights birth, adoption, or placement for
If you are declining enrollment for yourself or your dependents (including your spouse) adoption, you may be able to enroll
yourself and your dependents .
because of other health insurance or group health plan coverage, you may be able to later However, you must request
enroll yourself and your dependents in this plan if you or your dependents lose eligibility enrollment within 30 days after
for that other coverage (or if the employer stops contributing toward your or your the marriage, birth, adoption, or
dependents’ other coverage) .
placement for adoption .
Loss of eligibility includes but is not limited to: To request special enrollment or
X Loss of eligibility for coverage as a result of ceasing to meet the plan’s eligibility obtain more information, contact
requirements (i .e ., legal separation, divorce, cessation of dependent status, death your local Human Resources
of an employee, termination of employment, reduction in the number of hours of representative .
employment); * This notice is relevant for healthcare
X Loss of HMO coverage because the person no longer resides or works in the HMO coverages subject to the HIPAA
service area and no other coverage option is available through the HMO plan sponsor; portability rules
X Elimination of the coverage option a person was enrolled in, and another option is not
offered in its place;
X Failing to return from an FMLA leave of absence; and
X Loss of coverage under Medicaid or the Children’s Health Insurance Program (CHIP) .
Unless the event giving rise to your special enrollment right is a loss of coverage under
Medicaid or CHIP, you must request enrollment within 30 days after your or your
dependent’s(s’) other coverage ends (or after the employer that sponsors that coverage
stops contributing toward the coverage) .
9
