Page 137 - 2021 Medical Plan SPD

Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH
Building Washington, D.C. 20201

For purposes of the Language Assistance Services and this Non-Discrimination Notice ("Notice"), "The
Claims Administrator" refers to the entities listed in Footnote 2 of the Notice of Privacy Practices and
Footnote 3 of the Financial Information Privacy Notice. Please note that not all entities listed are covered
by this Notice.

Important Notices under the Patient Protection and Affordable Care
Act (PPACA)

Changes in Federal Law that Impact Benefits

There are changes in Federal law which may impact coverage and Benefits stated in the Summary Plan
Description (SPD) and Schedule of Benefits. A summary of those changes and the dates the changes are
effective appear below. These changes will apply to any "non-grandfathered" plan. Contact your Plan
Administrator to determine whether or not your plan is a "grandfathered" or a "non-grandfathered plan".
Under the Patient Protection and Affordable Care Act (PPACA) a plan generally is "grandfathered" if it
was in effect on March 23, 2010 and there are no substantial changes in the benefit design as described
in the Interim Final Rule on Grandfathered Health Plans at that time.

Patient Protection and Affordable Care Act (PPACA)
Effective for policies that are new or renewing on or after September 23, 2010, the requirements listed
below apply.

• Lifetime limits on the dollar amount of essential benefits available to you under the terms of your
plan are no longer permitted. Essential benefits include the following:

Ambulatory patient services; emergency services, hospitalization; laboratory services; maternity
and newborn care, mental health and substance use disorder services (including behavioral health
treatment); prescription drugs; rehabilitative and habilitative services and devices; preventive and
wellness services and chronic disease management; and pediatric services, including oral and
vision care.
• On or before the first day of the first plan year beginning on or after September 23, 2010, the
enrolling group will provide a 30 day enrollment period for those individuals who are still eligible
under the plan's eligibility terms but whose coverage ended by reason of reaching a lifetime limit on
the dollar value of all benefits.

• Essential benefits for plan years beginning prior to January 1, 2014 can only be subject to
restricted annual limits. Restricted annual limits for each person covered under the plan may be no
less than the following:
 For plan or policy years beginning on or after September 23, 2010 but before September 23,
2011, $750,000.
 For plan or policy years beginning on or after September 23, 2011 but before September 23,
2012, $1,250,000.
 For plan or policy years beginning on or after September 23, 2012 but before January 1,
2014, $2,000,000.

Please note that for plan years beginning on or after January 1, 2014, essential health benefits
cannot be subject to annual or lifetime dollar limits.

3 Federal Notice