Page 2 - 2018 MDT Benefits & Notices
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Member Driven Technologies (MDT) 2018
Table of Contents
Introduction .................................................................................................................................... 4
Changing Your Benefits ................................................................................................................... 4
Newborns’ & Mothers’ Health Protection ........................................................................................ 5
Women’s Health & Cancer Rights Act (WHCRA) ............................................................................... 5
Protecting Your Privacy ................................................................................................................... 5
Qualified Medical Child Support Order Notice ................................................................................. 5
Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) Notice ............. 6
The Genetic Information Nondiscrimination Act of 2008 (GINA) Notice ........................................... 6
Special Enrollment Notice ................................................................................................................ 6
New Health Insurance Marketplace Coverage Options and Your Health Coverage ........................... 7
Medical Coverage ........................................................................................................................... 9
Waiver of Medical Coverage – Opt Out Option ................................................................................ 9
Dental Coverage ........................................................................................................................... 12
Vision Coverage ............................................................................................................................ 13
Health Reimbursement Arrangement (HRA) .................................................................................. 14
Flexible Spending Accounts (FSA) ................................................................................................... 15
Basic Life/Accidental Death & Dismemberment (AD&D)/Optional Life Coverage ............................ 17
Short Term Disability (STD) Coverage ............................................................................................ 17
Long Term Disability (LTD) Coverage ............................................................................................. 18
Employee Contributions ................................................................................................................ 19
For More Information About Our Coverage ................................................................................... 19
General Notice of COBRA Continuation Coverage Rights ................................................................ 20
Notice of Creditable Coverage for Medicare Rx .............................................................................. 24
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) ............. 26
Summary of Benefits Coverage – Active Employee Plan PPO 15/0 5000 ......................................... 29
Notes ............................................................................................................................................ 37
Information about Medicare
If you have Medicare or will become eligible for Medicare within the next 12 months, a new Federal law
gives you more choices about your prescription drug coverage. Please see pages 24-25 for details.
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