Page 27 - HIMSS 2021 Annual Benefits Enrollment
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WOMEN’S HEALTH AND CANCER RIGHTS NOTICE
Healthcare Information and Management Systems Society Employee Health Care Plan is required by law to provide you with the
following notice:
The Women’s Health and Cancer Rights Act of 1998 (“WHCRA”) provides certain protections for individuals receiving mastectomy-
related benefits. Coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance;
Prostheses; and
Treatment of physical complications of the mastectomy, including lymphedemas.
The Healthcare Information and Management Systems Society Employee Health Care Plan provide(s) medical coverage for mastectomies
and the related procedures listed above, subject to the same deductibles and coinsurance applicable to other medical and surgical
benefits provided under this plan. Therefore, the following deductibles and coinsurance apply:
HDHP In-Network Out-of-Network
Individual Deductible $3,000 $6,000
Family Deductible $6,000 $12,000
Coinsurance 80% 60%
PPO In-Network Out-of-Network
Individual Deductible $1,500 $3,000
Family Deductible $3,000 $6,000
Coinsurance 80% 60%
HMO In-Network Out-of-Network
Individual Deductible $0 N/A
Family Deductible $0 N/A
Coinsurance 100% N/A
If you would like more information on WHCRA benefits, please refer to your Policy Booklet or contact your Plan Administrator at:
Eileen Murphy
Total Rewards & HRIS Manager
312-915-9242
PREMIUM ASSISTANCE UNDER MEDICAID plan if you aren’t already enrolled. This is called a “special
AND THE CHILDREN’S HEALTH INSURANCE enrollment” opportunity, and you must request coverage within
60 days of being determined eligible for premium assistance.
PROGRAM (CHIP) If you have questions about enrolling in your employer plan,
If you or your children are eligible for Medicaid or CHIP and contact the Department of Labor at www.askebsa.dol.gov or call
you’re eligible for health coverage from your employer, your state 1-866-444-EBSA (3272).
may have a premium assistance program that can help pay for
coverage, using funds from their Medicaid or CHIP programs. If you live in one of the following states, you may be eligible for
If you or your children aren’t eligible for Medicaid or CHIP, you assistance paying your employer health plan premiums. The
won’t be eligible for these premium assistance programs but you following list of states is current as of July 31, 2020. Contact your
may be able to buy individual insurance coverage through the State for more information on eligibility –
Health Insurance Marketplace. For more information, visit www.
healthcare.gov. ALABAMA –MEDICAID
If you or your dependents are already enrolled in Medicaid or Website: http://myalhipp.com/
CHIP and you live in a State listed below, contact your State Phone: 1-855-692-5447
Medicaid or CHIP office to find out if premium assistance is
available. ALASKA – Medicaid
If you or your dependents are NOT currently enrolled in Medicaid The AK Health Insurance Premium Payment Program
or CHIP, and you think you or any of your dependents might be Website: http://myakhipp.com/
eligible for either of these programs, contact your State Medicaid
or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow. Phone: 1-866-251-4861
gov to find out how to apply. If you qualify, ask your state if it Email: CustomerService@MyAKHIPP.com
has a program that might help you pay the premiums for an
employer-sponsored plan. Medicaid Eligibility:
If you or your dependents are eligible for premium assistance http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
under Medicaid or CHIP, as well as eligible under your employer
plan, your employer must allow you to enroll in your employer
27
Healthcare Information and Management Systems Society Employee Health Care Plan is required by law to provide you with the
following notice:
The Women’s Health and Cancer Rights Act of 1998 (“WHCRA”) provides certain protections for individuals receiving mastectomy-
related benefits. Coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance;
Prostheses; and
Treatment of physical complications of the mastectomy, including lymphedemas.
The Healthcare Information and Management Systems Society Employee Health Care Plan provide(s) medical coverage for mastectomies
and the related procedures listed above, subject to the same deductibles and coinsurance applicable to other medical and surgical
benefits provided under this plan. Therefore, the following deductibles and coinsurance apply:
HDHP In-Network Out-of-Network
Individual Deductible $3,000 $6,000
Family Deductible $6,000 $12,000
Coinsurance 80% 60%
PPO In-Network Out-of-Network
Individual Deductible $1,500 $3,000
Family Deductible $3,000 $6,000
Coinsurance 80% 60%
HMO In-Network Out-of-Network
Individual Deductible $0 N/A
Family Deductible $0 N/A
Coinsurance 100% N/A
If you would like more information on WHCRA benefits, please refer to your Policy Booklet or contact your Plan Administrator at:
Eileen Murphy
Total Rewards & HRIS Manager
312-915-9242
PREMIUM ASSISTANCE UNDER MEDICAID plan if you aren’t already enrolled. This is called a “special
AND THE CHILDREN’S HEALTH INSURANCE enrollment” opportunity, and you must request coverage within
60 days of being determined eligible for premium assistance.
PROGRAM (CHIP) If you have questions about enrolling in your employer plan,
If you or your children are eligible for Medicaid or CHIP and contact the Department of Labor at www.askebsa.dol.gov or call
you’re eligible for health coverage from your employer, your state 1-866-444-EBSA (3272).
may have a premium assistance program that can help pay for
coverage, using funds from their Medicaid or CHIP programs. If you live in one of the following states, you may be eligible for
If you or your children aren’t eligible for Medicaid or CHIP, you assistance paying your employer health plan premiums. The
won’t be eligible for these premium assistance programs but you following list of states is current as of July 31, 2020. Contact your
may be able to buy individual insurance coverage through the State for more information on eligibility –
Health Insurance Marketplace. For more information, visit www.
healthcare.gov. ALABAMA –MEDICAID
If you or your dependents are already enrolled in Medicaid or Website: http://myalhipp.com/
CHIP and you live in a State listed below, contact your State Phone: 1-855-692-5447
Medicaid or CHIP office to find out if premium assistance is
available. ALASKA – Medicaid
If you or your dependents are NOT currently enrolled in Medicaid The AK Health Insurance Premium Payment Program
or CHIP, and you think you or any of your dependents might be Website: http://myakhipp.com/
eligible for either of these programs, contact your State Medicaid
or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow. Phone: 1-866-251-4861
gov to find out how to apply. If you qualify, ask your state if it Email: CustomerService@MyAKHIPP.com
has a program that might help you pay the premiums for an
employer-sponsored plan. Medicaid Eligibility:
If you or your dependents are eligible for premium assistance http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
under Medicaid or CHIP, as well as eligible under your employer
plan, your employer must allow you to enroll in your employer
27
