Page 39 - HarborLight CU 2014-15 SPD
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lified Medical Child Support Order (QMCSO) or National Medical Support
Notice (NMSN)
Any court order that: 1) provides for child support with respect to the employee’s child or directs
the employee to provide coverage under a health benefit plan under a state domestic relations
law, or 2) enforces a law relating to medical child support described in the Social Security Act,
Section 1908, with respect to a group health plan. A QMCSO or an NMSN also may be issued
through an administrative process established under state law. A participant must notify the Plan
Administrator if he or she is subject to a QMCSO or an NMSN.
USERRA
The Uniformed Services Employment and Reemployment Rights Act of 1994; a Federal law
covering the rights of participants who have a qualified uniformed services leave.
WHCRA
The Women’s Health and Cancer Rights Act of 1998, as amended. Your medical coverage
under the Plan includes coverage for a medically necessary mastectomy and patient-elected
reconstruction after the mastectomy. Specifically, for you or your covered dependent who is
receiving mastectomy-related benefits, coverage will be provided in a manner determined in
consultation with the attending physician and the patient for: 1) All stages of reconstruction of
the breast on which the mastectomy was performed; 2) Surgery and reconstruction of the other
breast to produce a symmetrical appearance; 3) Prostheses; and 4) Treatment of physical
complications at all stages of mastectomy, including lymphedema.
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Notice (NMSN)
Any court order that: 1) provides for child support with respect to the employee’s child or directs
the employee to provide coverage under a health benefit plan under a state domestic relations
law, or 2) enforces a law relating to medical child support described in the Social Security Act,
Section 1908, with respect to a group health plan. A QMCSO or an NMSN also may be issued
through an administrative process established under state law. A participant must notify the Plan
Administrator if he or she is subject to a QMCSO or an NMSN.
USERRA
The Uniformed Services Employment and Reemployment Rights Act of 1994; a Federal law
covering the rights of participants who have a qualified uniformed services leave.
WHCRA
The Women’s Health and Cancer Rights Act of 1998, as amended. Your medical coverage
under the Plan includes coverage for a medically necessary mastectomy and patient-elected
reconstruction after the mastectomy. Specifically, for you or your covered dependent who is
receiving mastectomy-related benefits, coverage will be provided in a manner determined in
consultation with the attending physician and the patient for: 1) All stages of reconstruction of
the breast on which the mastectomy was performed; 2) Surgery and reconstruction of the other
breast to produce a symmetrical appearance; 3) Prostheses; and 4) Treatment of physical
complications at all stages of mastectomy, including lymphedema.
34
