Page 29 - 2022 DPR Construction Benefit Guide_Craft Employees

Important Notices

Women’s Health & Cancer Rights Act Newborns’ and Mothers’ Health
(WHCRA) Protection Act

If you have had or are going to have a mastectomy, you may Group health plans and health insurance issuers generally may
be entitled to certain benefits under the Women’s Health and not, under Federal law, restrict benefits for any hospital length of
Cancer Rights Act of 1998 (WHCRA). For individuals receiving stay in connection with childbirth for the mother or newborn child
mastectomy-related benefits, coverage will be provided in to less than 48 hours following a vaginal delivery, or less than 96
a manner determined in consultation with the attending hours following a cesarean section. However, Federal law generally
physician and the patient, for: does not prohibit the mother’s or newborn’s attending provider,
• All stages of reconstruction of the breast on which the after consulting with the mother, from discharging the mother or
mastectomy was performed; her newborn earlier than 48 hours (or 96 hours as applicable). In
• Surgery and reconstruction of the other breast to produce any case, plans and issuers may not, under Federal law, require
a symmetrical appearance; that a provider obtain authorization from the plan or the insurance
issuer for prescribing a length of stay not in excess of 48 hours
• Prostheses; and (or 96 hours).
• Treatment of physical complications of the mastectomy,
including lymphedema. Premium Assistance under Medicaid and the
These benefits will be provided subject to the same Children’s Health Insurance Program (CHIP)
deductibles and coinsurance applicable to other medical If you or your children are eligible for Medicaid or CHIP and
and surgical benefits provided under this plan. Therefore, you’re eligible for health coverage from your employer, your state
the following network deductibles and coinsurance apply: may have a premium assistance program that can help pay for
Cigna PPO (high): 10% after $500 deductible; Cigna PPO coverage, using funds from their Medicaid or CHIP programs.
(low): 20% after 750 deductible; Cigna HDHP: 10% after $1,750 If you or your children aren’t eligible for Medicaid or CHIP, you
deductible, Kaiser: no deductibles or coinsurance.
won’t be eligible for these premium assistance programs but you
If you would like more information on WHCRA benefits, call may be able to buy individual insurance coverage through the
your plan administrator Anne Anderson at 650-306-7700. Health Insurance Marketplace. For more information, visit www.
healthcare.gov.
Patient Protection Notice If you or your dependents are already enrolled in Medicaid or
Kaiser Permanente Northern CA: 600261 and Kaiser CHIP and you live in a State listed below, contact your State
Southern CA: 227141 HMO plans generally requires the Medicaid or CHIP office to find out if premium assistance
designation of a primary care provider. You have the right is available.
to designate any primary care provider who participates If you or your dependents are NOT currently enrolled in
in the network and who is available to accept you or your Medicaid or CHIP, and you think you or any of your dependents
family members. Until you make this designation, Kaiser might be eligible for either of these programs, contact your
Permanente designates one for you. For information State Medicaid or CHIP office or dial
on how to select a primary care provider, and for a list of 1-877-KIDS NOW or www.insurekidsnow.gov to find out how
the participating primary care providers, contact Kaiser to apply. If you qualify, ask your state if it has a program that
Permanente at 1-800-464-4000. might help you pay the premiums for an employer-sponsored
For children, you may designate a pediatrician as the primary plan.
care provider. If you or your dependents are eligible for premium assistance
You do not need prior authorization from Kaiser Permanente under Medicaid or CHIP, as well as eligible under your employer
or from any other person (including a primary care provider) plan, your employer must allow you to enroll in your employer
in order to obtain access to obstetrical or gynecological plan if you aren’t already enrolled. This is called a “special
care from a health care professional in the network who enrollment” opportunity, and you must request coverage within
specializes in obstetrics or gynecology. The health care 60 days of being determined eligible for premium assistance.
professional, however, may be required to comply with If you have questions about enrolling in your employer plan,
certain procedures, including obtaining prior authorization contact the Department of Labor at www.askebsa.dol.gov or
for certain services, following a pre-approved treatment plan, call 1-866-444-EBSA (3272).
or procedures for making referrals. For a list of participating If you live in one of the following states, you may be eligible
health care professionals who specialize in obstetrics or for assistance paying your employer health plan premiums.
gynecology, contact Kaiser Permanente at 1-800-464-4000. The following list of states is current as of July 31, 2021.
Contact your State for more information on eligibility.
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