Page 15 - SEARCH Day Program Benefit Guide 2020-2021

A GUIDE TO YOUR BENEFITS | 2020

Important Notices

EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA)

The Employee Retirement Income Security Act (ERISA) requires plan administrators - the people who manage plans - to give plan participants in
writing the most important facts they need to know about their retirement and health benefit plans including plan rules, financial information, and
documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by
the plan administrator. Upon written request, others are available, free-of-charge for minimal copying fees.

CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA)

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose
to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or
involuntary job loss, reduction the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be
required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

HEALTH INSURANCE PORTATIBLITY AND ACCOUNTABILITY ACT (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) provide rights and protections for participants and beneficiaries in group health
plans. HIPAA prohibits discrimination against Associates and dependents based on their health status; and allow a special opportunity to enroll in
a new plan to individuals in certain circumstances. HIPAA may also give participants a right to purchase individual coverage if no group health plan
coverage is available, and have exhausted COBRA or other continuation coverage

MENTAL HEALTH PARITY AND ADDICTION ACT EQUITY ACT OF 2008

This act expands the mental health parity requirements in the Employee Retirement Income Security Act, the Internal Revenue Code and the
Public Health Services Act by imposing new mandates on group health plans that provide both medical and surgical benefits and mental health or
substance abuse disorder benefits. Among the new requirements, such plans (or the health insurance coverage offered in connection with such
plans) must ensure that the financial requirements applicable to mental health or substance abuse disorder benefits are no more restrictive than
the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan (or coverage), and there are
no separate cost sharing requirements that are applicable only with respect to mental health or substance abuse disorder benefits.

NEWBORNS AND MOTHERS HEALTH PROTECTION ACT

The Newborns and Mothers Health Protection Act (Newborns Act) requires group health plans that offer maternity hospital benefits for mothers
and newborns to pay for at least a 48-hour hospital stay for the mother and newborn following childbirth (or, in the case of a cesarean section, 96-
hour hospital stay), unless the attending provider, in consultation with the mother, decides to discharge earlier.

QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO)

QMCSO is a medical child support order issued under State law that creates or recognizes the existence of an “alternate recipient's” right to receive
benefits for which a participant or beneficiary is eligible under a group health plan. An “alternate recipient” is any child of a participant (including a
child adopted by or placed for adoption with a participant in a group health plan) who is recognized under a medical child support order as having a
right to enrollment under a group health plan with respect to such participant. Upon receipt, the administrator of a group health plan is required to
determine, within a reasonable period of time, whether a medical child support order is qualified, and to administer benefits in accordance with the
applicable terms of each order that is qualified. In the event you are served with a notice to provide medical coverage for a dependent child as the
result of a legal determination, you may obtain information from your employer on the rules for seeking to enact such coverage. These rules are
provided at no cost to you and may be requested from your employer at any time.

WOMEN’S HEALTH AND CANCER RIGHTS (WHCRA)

Special Rights Following Mastectomy. A group health plan generally must, under federal law, make certain benefits available to participants who
have undergone a mastectomy. In particular, a plan must offer mastectomy patients benefits for:

• Reconstruction of the breast on which the mastectomy has been performed
• Surgery and reconstruction of the other breast to produce a symmetrical appearance
• Prostheses
• Treatment of physical complications of mastectomy
Our Plan complies with these requirements. Benefits for these items generally are comparable to those provided under our Plan for similar types of
medical services and supplies. Of course, the extent to which any of these items is appropriate following mastectomy is a matter to be determined
by consultation between the attending physician and the patient. Our Plan neither imposes penalties (for example, reducing or limiting
reimbursements) nor provides Incentives to induce attending providers to provide care inconsistent with these requirements.

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