Page 56 - 2020 Benefit

A Guide to Your Health and Wellness Benefits | 2020

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.
Patient Protection Notice
Choose a primary care provider or a pediatrician when a plan requires designation of a primary care physician.

Sungevity’s Health and Welfare Benefit Plan generally allows the designation of a primary care provider. You have the right to
designate any primary care provider who participates in our networks and who is available to accept you or your family members.
For children, you may designate a pediatrician as the primary care provider.

For information on how to select a primary care provider, and for a list of the participating primary care providers, contact Anthem
at 800-888-8288. Obtain obstetrical or gynecological care without prior authorization

You do not need prior authorization from Sungevity’s Health and Welfare Benefit Plan or from any other person (including a
primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network
who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain
procedures, including obtaining prior authorization for certain services, following a preapproved treatment plan, or procedures for
making referrals.

For a list of participating health care professionals who specialize in obstetrics or gynecology, contact Anthem at 800-888-8288.

Generic Information Nondiscrimination Act (GINA)
The Genetic Information Nondiscrimination Act (GINA) prohibits collection of genetic information by both employers and health
plans, and defines genetic information very broadly. Asking an individual to provide family medical history is considered collection
of genetic information, even if there is no reward for responding (or penalty for failure to respond). In addition, a question about an
individual's current health status is considered to be a request for genetic information if it is made in a way likely to result in
obtaining genetic information (e.g., family medical history). Wellness programs that require completion of health risk assessments
or other forms that request health information may violate the collection prohibition unless they fit within an exception to the
prohibition for inadvertent acquisition of such information. This exception applies if the request does not violate any laws, does not
ask for genetic information and includes a warning against providing genetic information in any responses.
In answering these questions, do not include any genetic information. The Genetic Information Nondiscrimination Act of 2008
(GINA) prohibits employers and other entities covered by GINA from requesting or requiring genetic information of an individual or
family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not
provide any genetic information when responding to this request. “Genetic information” as defined by GINA, includes an
individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an
individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an
individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
Please do not include any family medical history or any information related to genetic testing, genetic services, genetic counseling
or genetic diseases for which an individual may be at risk.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

27 | 2020 Benefit Guide