Page 35 - 2022 DPR Construction Benefit Guide_Craft Employees

Notice of Availability of DPR Construction You are protected from balance billing for:
Notice of Privacy Practices Emergency services

THIS NOTICE DESCRIBES HOW YOU MAY OBTAIN If you have an emergency medical condition and get emergency
A COPY OF THE PLAN’S NOTICE OF PRIVACY services from an out-of-network provider or facility, the most the
PRACTICES, WHICH DESCRIBES THE WAYS THAT provider or facility may bill you is your plan’s in-network cost-sharing
THE PLAN USES AND DISCLOSES YOUR PROTECTED amount (such as copayments and coinsurance). You can’t be
HEALTH INFORMATION. balance billed for these emergency services. This includes services
you may get after you’re in stable condition, unless you give written
DPR Construction Health & Welfare Plan (the “Plan”) consent and give up your protections not to be balanced billed for
provides health benefits to eligible employees of DPR these post-stabilization services.
Construction (the “Company”) and their eligible dependents
as described in the summary plan description(s) for the Plan. Certain services at an in-network hospital or ambulatory
The Plan creates, receives, uses, maintains and discloses surgical center
health information about participating employees and When you get services from an in-network hospital or ambulatory
dependents in the course of providing these health benefits. surgical center, certain providers there may be out-of-network. In
The Plan is required by law to provide notice to participants these cases, the most those providers may bill you is your plan’s in-
of the Plan’s duties and privacy practices with respect to network cost-sharing amount. This applies to emergency medicine,
covered individuals’ protected health information, and anesthesia, pathology, radiology, laboratory, neonatology, assistant
has done so by providing to Plan participants a Notice of surgeon, hospitalist, or intensivist services. These providers can’t
Privacy Practices, which describes the ways that the Plan balance bill you and may not ask you to give up your protections not
uses and discloses protected health information. To receive to be balance billed.
a copy of the Plan’s Notice of Privacy Practices you should
contact Anne Anderson, who has been designated as the If you get other services at these in-network facilities, out-of-network
Plan’s contact person for all issues regarding the Plan’s providers can’t balance bill you, unless you give written consent and
privacy practices and covered individuals’ privacy rights. You give up your protections.
can reach this contact person at: 650-306-7700 and 1450 You’re never required to give up your protections from
Veterans Blvd. Redwood City, CA 94063.
balance billing. You also aren’t required to get care out-
of-network. You can choose a provider or facility in your
Your Rights and Protections Against Surprise plan’s network.
Medical Bills
When balance billing isn’t allowed, you also have the
When you get emergency care or get treated by an following protections:
out-of-network provider at an in-network hospital or • You are only responsible for paying your share of the cost
ambulatory surgical center, you are protected from (like the copayments, coinsurance, and deductibles that
surprise billing or balance billing. you would pay if the provider or facility was in-network).
What is “balance billing” (sometimes called Your health plan will pay out-of-network providers and
“surprise billing”)? facilities directly.
• Your health plan generally must:
When you see a doctor or other health care provider, you – Cover emergency services without requiring you to get
may owe certain out-of-pocket costs, such as a copayment, approval for services in advance (prior authorization).
coinsurance, and/or a deductible. You may have other costs
or have to pay the entire bill if you see a provider or visit a – Cover emergency services by out-of-network providers.
health care facility that isn’t in your health plan’s network. – Base what you owe the provider or facility (cost-sharing)
on what it would pay an in network provider or facility
“Out-of-network” describes providers and facilities that and show that amount in your explanation of benefits.
haven’t signed a contract with your health plan. Out-of-
network providers may be permitted to bill you for the – Count any amount you pay for emergency services or
difference between what your plan agreed to pay and the full out-of-network services toward your deductible and
amount charged for a service. This is called “balance billing.” out-of-pocket limit.
This amount is likely more than in-network costs for the same If you believe you’ve been wrongly billed, you may contact
service and might not count toward your annual out-of- Anne Anderson at 650-474-1450.
pocket limit.
Visit www.dol.gov/ebsa for more information about your rights
“Surprise billing” is an unexpected balance bill. This can under federal law.
happen when you can’t control who is involved in your care—
like when you have an emergency or when you schedule a
visit at an in-network facility but are unexpectedly treated by
an out-of-network provider.

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