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Alternate Recipients Under Qualiied Medical Child Support Orders. A child of the Women’s Health and
covered employee or former employee who is receiving beneits under the plan Cancer Rights Notice
pursuant to a Qualiied Medical Child Support Order (QMCSO) received by the Plan
Administrator during the employee’s period of employment with the employer is The Company Employee Health Care Plan
entitled the same rights under COBRA as an eligible child of the covered employee, is required by law to provide you with the
regardless of whether that child would otherwise be considered a dependent. Be sure following notice:
to promptly notify the Plan Administrator or its designee if you need to make a change
to your COBRA coverage. The Plan Administrator or its designee must be notiied in The Women’s Health and Cancer Rights
writing within 30 days of the date you wish to make such a change. See the rules in Act of 1998 (“WHCRA”) provides certain
the box above, under the heading entitled, “Notice Procedures,” for an explanation protections for individuals receiving
regarding how your notice should be made. mastectomy-related beneits. Coverage
will be provided in a manner determined
Are There Other Coverage Options Besides Cobra Continuation in consultation with the attending
Coverage? physician and the patient for:
Yes. Instead of enrolling in COBRA continuation coverage, there may be other All stages of reconstruction of the
coverage options for you and your family through the Health Insurance Marketplace, breast on which the mastectomy was
performed
Medicaid, or other group health plan coverage options (such as a spouse’s plan)
through what is called a “special enrollment period.” Some of these options may cost Surgery and reconstruction of
the other breast to produce a
less than COBRA continuation coverage. You can learn more about many of these symmetrical appearance
options at www.healthcare.gov.
Prostheses
If You Have Questions Treatment of physical complications
Questions concerning your Plan or your COBRA continuation coverage rights should of the mastectomy, including
lymphedemas
be addressed to the contact or contacts identiied below. For more information
about your rights under ERISA, including COBRA, the Health Insurance Portability The Company Employee Health Care
or Accountability Act (HIPAA), and other laws affecting group health plans, contact Plan provide(s) medical coverage for
the nearest Regional or District Ofice of the U.S. Department of Labor’s Employee mastectomies and the related procedures
Beneits Security Administration (EBSA). Addresses and phone numbers of Regional listed above, subject to the same
and District EBSA Ofices are available through EBSA’s Web site at www.dol.gov/ebsa. deductibles and coinsurance applicable
to other medical and surgical beneits
Keep Your Plan Informed of Address Changes
provided under this plan.
To protect your family’s rights, let the Plan Administrator know about any changes in
the addresses s of family members. You should also keep a copy, for your records, of If you would like more information on
any notices you send to the Plan Administrator. WHCRA beneits, please refer to your
Summary Plan Description or contact
Plan Contact Information your Plan Administrator.
Beneits Administrator
314.584.6629
OMB Control Number 1210-0123 (expires 10/31/2016)
2016 Open Enrollment
Alternate Recipients Under Qualiied Medical Child Support Orders. A child of the Women’s Health and
covered employee or former employee who is receiving beneits under the plan Cancer Rights Notice
pursuant to a Qualiied Medical Child Support Order (QMCSO) received by the Plan
Administrator during the employee’s period of employment with the employer is The Company Employee Health Care Plan
entitled the same rights under COBRA as an eligible child of the covered employee, is required by law to provide you with the
regardless of whether that child would otherwise be considered a dependent. Be sure following notice:
to promptly notify the Plan Administrator or its designee if you need to make a change
to your COBRA coverage. The Plan Administrator or its designee must be notiied in The Women’s Health and Cancer Rights
writing within 30 days of the date you wish to make such a change. See the rules in Act of 1998 (“WHCRA”) provides certain
the box above, under the heading entitled, “Notice Procedures,” for an explanation protections for individuals receiving
regarding how your notice should be made. mastectomy-related beneits. Coverage
will be provided in a manner determined
Are There Other Coverage Options Besides Cobra Continuation in consultation with the attending
Coverage? physician and the patient for:
Yes. Instead of enrolling in COBRA continuation coverage, there may be other All stages of reconstruction of the
coverage options for you and your family through the Health Insurance Marketplace, breast on which the mastectomy was
performed
Medicaid, or other group health plan coverage options (such as a spouse’s plan)
through what is called a “special enrollment period.” Some of these options may cost Surgery and reconstruction of
the other breast to produce a
less than COBRA continuation coverage. You can learn more about many of these symmetrical appearance
options at www.healthcare.gov.
Prostheses
If You Have Questions Treatment of physical complications
Questions concerning your Plan or your COBRA continuation coverage rights should of the mastectomy, including
lymphedemas
be addressed to the contact or contacts identiied below. For more information
about your rights under ERISA, including COBRA, the Health Insurance Portability The Company Employee Health Care
or Accountability Act (HIPAA), and other laws affecting group health plans, contact Plan provide(s) medical coverage for
the nearest Regional or District Ofice of the U.S. Department of Labor’s Employee mastectomies and the related procedures
Beneits Security Administration (EBSA). Addresses and phone numbers of Regional listed above, subject to the same
and District EBSA Ofices are available through EBSA’s Web site at www.dol.gov/ebsa. deductibles and coinsurance applicable
to other medical and surgical beneits
Keep Your Plan Informed of Address Changes
provided under this plan.
To protect your family’s rights, let the Plan Administrator know about any changes in
the addresses s of family members. You should also keep a copy, for your records, of If you would like more information on
any notices you send to the Plan Administrator. WHCRA beneits, please refer to your
Summary Plan Description or contact
Plan Contact Information your Plan Administrator.
Beneits Administrator
314.584.6629
OMB Control Number 1210-0123 (expires 10/31/2016)
2016 Open Enrollment
