Page 22 - Tessenderlo Kerley, Inc 2022 Benefit Guide
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IMPORTANT LEGAL RIGHTS INFORMATION
Qualifying Events HIPAA Notification of Privacy Practices
If you experience a qualified life-status change or if you move out of your Tessenderlo Kerley Health Plan (the “Plan”) provides health benefits to
plan area, you may add or discontinue coverage that is consistent with eligible employees and their eligible dependents as described in the
the status change, by contacting Human Resources and submitting the summary plan description(s) for the Plan. The Plan creates, receives,
proper forms within 30 days of the event. uses, maintains and discloses health information about participating
employees and dependents in the course of providing these health
Qualifying Events include: benefits. The Plan is required by law to provide notice to participants
• Marriage, divorce, or legal separation of the Plan’s duties and privacy practices with respect to covered
• Birth of a child individuals’ protected health information, and has done so by providing to
• Death of a dependent Plan participants a Notice of Privacy Practices, which describes the ways
• Placement of a child with you for adoption or foster care that the Plan uses and discloses protected health information. To receive
a copy of the Plan’s Notice of Privacy Practices you should contact your
• Change in your or your spouse’s employment status Benefits representative, who has been designated as the Plan’s contact
• Receiving qualified Medical Child Support Order (QMCSO) person for all issues regarding the Plan’s privacy practices and covered
individuals’ privacy rights. You can reach this contact person at the
Women’s Health & Cancer Rights Act address and phone number at the top of this page.
Do you know that your plan, as required by the Women’s Health and
Cancer Right Act of 1998, provides benefits for mastectomy-related COBRA
services, including all stages of reconstruction and surgery to achieve The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
symmetry between the breasts, prostheses and treatment for complications provides for continued coverage for a certain period of time at applicable
resulting from a mastectomy, including lymphedema? Contact your Human monthly COBRA rates if you, your spouse, or your dependents lose group
Resources representative at one of the phone numbers provided above for medical, dental, or vision coverage because you terminate employment
more information. (for reason other than gross misconduct); your work hours are reduced
below the eligible status for these benefits; you die, divorce, or are legally
Our plan complies with these requirements. Benefits for these items separated; or a child ceases to be an eligible dependent.
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 the patient and her physician. 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. If you would like more information about WHCRA
required coverage, you can contact Human Resources.
WELCOME BENEFIT BASICS MEDICAL DENTAL VISION FSA ADDITIONAL BENEFITS 401(k) CONTACTS LEGAL RIGHTS 22
