Page 26 - Immucor Benefit Guide

Women’s Health and Cancer Rights Act Notice

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the
Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related
benefits,coverage will be provided in a manner determined in consultationwith the attendingphysician
and the patient,for:

✓ All stages of reconstructionof the breast on which the mastectomy was performed;
✓ Surgery and reconstructionof the other breast to producea symmetrical appearance;
✓ Prostheses;and
✓ Treatment of physicalcomplications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductiblesand coinsuranceapplicableto other
medical and surgical benefits provided under this plan. Therefore, the aforementioned deductibles
and coinsuranceapply.
If you would like more information on WHCRA benefits, call your plan administrator.

Notice to Enrollees in a Self-Funded Nonfederal Governmental Group HealthPlan
Group health plans sponsored by State and localgovernmentalemployersmust generally comply with Federal law
requirements in title XXVII of the Public Health Service Act. However, these employers are permitted to elect to
exempt a plan from the requirements listed below for any part of the plan that is "self-funded" by the employer,
rather than provided through a health insurance policy. (Name of plan sponsor) has elected to exempt Immucor
from (all)(or specify which ones) of the following requirements:

1. Protectionagainst limiting hospitalstays in connectionwith the birth of a child to less than 48
hours for a vaginal delivery, and 96 hours for acesarean section.
2. Protectionsagainst havingbenefits for mental health and substanceuse disordersbe subject to
more restrictions than applyto medical and surgical benefits covered by the plan.
3. Certain requirements to provide benefits for breast reconstruction after amastectomy.
4. Continued coverage for up to one year for a dependent child who is covered as a dependent
under the plan solely based on student status, who takes a medicallynecessary leave of absence
from a postsecondary educationalinstitution.

The exemption from these Federal requirements will be in effect for the 2022 plan year
beginning 1.1.22 and ending 12.31.22. The election may be renewed for subsequent plan years.

[If the Plan provides protectionssimilarto any of the exempted requirements, either voluntarily or in accordance
with State law, those protectionsmay be identified.]

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