Page 26 - 2021 Sample Benefit Booklet

Health Care Reform

Patient Protection Disclosure – Non-GrandfatheredPlans
Kaiser Permanente generally allows the designation of a primary care provider.
You have the right to designate any primary care provider who participates in the network and who is availa-

ble to accept you and/or your family members. For information on how to select a primary care provider, and
for a list of participating primary care providers, contact:

Kaiser Permanente 1.800.788.0710

Sutter Health Plus

You do not need prior authorization from Kaiser Permanente, Sutter Health Plus, 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 or specializes in obstetrics or gynecology. The health care professional, how-
ever, may be required to comply with certain procedures, including obtaining prior authorization for certain
services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating
health care professionals who specialize in obstetrics or gynecology, contact :

Kaiser Permanente at 1.800.788.0710.

Rebates for Failure to meet Medical Loss Ratio Requirements
In the event that ABC Group qualifies and receives a return of premium (Rebate) as a result of an
insurance issuer’s failure to meet the Medical Loss Ratio requirements under the Affordable Care Act, ABC
Group at its option, shalleither:

• Reduce annual premiums in the year in which the Rebate is received or in the subsequent year; or
• Reduce employee contributions or provide a cash refund (taxable to the employee) in an amount
determined under Affordable Care Actregulations.

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