Page 25 - 2015 Intertek USA Enrollment Guide
P. 25
If You Have Questions Women’s Health and Cancer Rights Notice
Questions concerning your Plan or your Intertek Employee Health Care Plan is required by law to provide you with the
COBRA continuation coverage rights following notice:
should be addressed to the contact
or contacts identiied below. For more The Women’s Health and Cancer Rights Act of 1998 (“WHCRA”) provides certain
information about your rights under the protections for individuals receiving mastectomy-related beneits. Coverage will be
Employee Retirement Income Security provided in a manner determined in consultation with the attending physician and
Act (ERISA), including COBRA, the Patient the patient for:
Protection and Affordable Care Act, and X All stages of reconstruction of the breast on which the mastectomy was
other laws affecting group health plans, performed
contact the nearest Regional or District X Surgery and reconstruction of the other breast to produce a symmetrical
Ofice of the U.S. Department of Labor’s appearance
Employee Beneits Security Administration
(EBSA) in your area or visit www.dol.gov/ X Prostheses
ebsa. (addresses and phone numbers of X Treatment of physical complications of the mastectomy, including
Regional and District EBSA Ofices are lymphedemas
available through EBSA’s website.) For more
information about the Marketplace, visit The Intertek Employee Health Care Plan provide(s) medical coverage for
www.HealthCare.gov. mastectomies and the related procedures listed above, subject to the same
deductibles and coinsurance applicable to other medical and surgical beneits
Keep Your Plan Informed of provided under this plan.
Address Changes
To protect your family’s rights, let the Plan If you would like more information on WHCRA beneits, please refer to your
Administrator know about any changes Summary Plan Description or contact your Plan Administrator.
in the addresses s of family members. Revised October 19, 2010
You should also keep a copy, for your
records, of any notices you send to the Plan
Administrator.
Plan Contact Information
Heather Schuerman
2 Riverway, Suite 500
Houston, TX 77056
(713) 543-3777
OMB Control Number 1210-0123 (expires
10/31/2016)
This Employee Beneits Newsletter is only intended to highlight some
of the major beneit provisions of the Company plan and should not be
relied upon as a complete detailed representation of the plan. Please
refer to the plan’s Summary Plan Descriptions for further detail. Should
this newsletter differ from the Summary Plan Descriptions, the Summary
Plan Descriptions prevail.
© 2014 Lockton, Inc. All rights reserved.
Images © 2014 Thinkstock. All rights reserved.
[Rev 10/09/14] EB\INTER08\EE Comm\Enrollment Guide\2015\15OE.pdf
Questions concerning your Plan or your Intertek Employee Health Care Plan is required by law to provide you with the
COBRA continuation coverage rights following notice:
should be addressed to the contact
or contacts identiied below. For more The Women’s Health and Cancer Rights Act of 1998 (“WHCRA”) provides certain
information about your rights under the protections for individuals receiving mastectomy-related beneits. Coverage will be
Employee Retirement Income Security provided in a manner determined in consultation with the attending physician and
Act (ERISA), including COBRA, the Patient the patient for:
Protection and Affordable Care Act, and X All stages of reconstruction of the breast on which the mastectomy was
other laws affecting group health plans, performed
contact the nearest Regional or District X Surgery and reconstruction of the other breast to produce a symmetrical
Ofice of the U.S. Department of Labor’s appearance
Employee Beneits Security Administration
(EBSA) in your area or visit www.dol.gov/ X Prostheses
ebsa. (addresses and phone numbers of X Treatment of physical complications of the mastectomy, including
Regional and District EBSA Ofices are lymphedemas
available through EBSA’s website.) For more
information about the Marketplace, visit The Intertek Employee Health Care Plan provide(s) medical coverage for
www.HealthCare.gov. mastectomies and the related procedures listed above, subject to the same
deductibles and coinsurance applicable to other medical and surgical beneits
Keep Your Plan Informed of provided under this plan.
Address Changes
To protect your family’s rights, let the Plan If you would like more information on WHCRA beneits, please refer to your
Administrator know about any changes Summary Plan Description or contact your Plan Administrator.
in the addresses s of family members. Revised October 19, 2010
You should also keep a copy, for your
records, of any notices you send to the Plan
Administrator.
Plan Contact Information
Heather Schuerman
2 Riverway, Suite 500
Houston, TX 77056
(713) 543-3777
OMB Control Number 1210-0123 (expires
10/31/2016)
This Employee Beneits Newsletter is only intended to highlight some
of the major beneit provisions of the Company plan and should not be
relied upon as a complete detailed representation of the plan. Please
refer to the plan’s Summary Plan Descriptions for further detail. Should
this newsletter differ from the Summary Plan Descriptions, the Summary
Plan Descriptions prevail.
© 2014 Lockton, Inc. All rights reserved.
Images © 2014 Thinkstock. All rights reserved.
[Rev 10/09/14] EB\INTER08\EE Comm\Enrollment Guide\2015\15OE.pdf
