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InformationYou Need to Know
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FULL-TIME AND PART-TIME (30 OR MORE HOURS PER WEEK)
UTAH – Medicaid and CHIP
WEST VIRGINIA – Medicaid
Website: Medicaid: http://health.utah.gov/medicaid
Website: http://mywvhipp.com/
CHIP: http://health.utah.gov/chip
Toll-free phone: 855-MyWVHIPP (1-855-699-8447)
Phone: 877-543-7669
VERMONT– Medicaid
WISCONSIN – Medicaid and CHIP
Website: http://www.greenmountaincare.org/
Website: https://www.dhs.wisconsin.gov/publications/p1/p10095. pdf
Phone: 800-250-8427
Phone: 800-362-3002
VIRGINIA – Medicaid and CHIP
WYOMING – Medicaid
Medicaid Website: http://www.coverva.org/programs_premium_ assistance.cfm
Website: https://wyequalitycare.acs-inc.com/
Medicaid Phone: 800-432-5924
Phone: 307-777-7531
CHIP Website: http://www.coverva.org/programs_premium_ assistance.cfm
CHIP Phone: 855-242-8282
WASHINGTON - Medicaid
Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program- administration/premium-payment-program
Phone: 800-562-3022 ext. 15473
Women’s Health and Cancer Rights Act
of 1998 (WHCRA) 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 consultation with the attending physician and the patient for:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under your selected medical plan. Therefore, the following deductibles and coinsurance apply: refer to the Schedule of Benefits or contact customer service (see Contact List in the guide) for information. If you would like more information on WHCRA benefits, call your plan administrator at the phone number listed in this guide on the Contact List page.
The HCSC Employee HMO health plans generally require the designation of a primary care provider (PCP). You have the right to designate any PCP who participates in the network and who is available
to accept you and/or your family members. For information on how to select a PCP, and for a list of the participating PCPs, refer to the appropriate HMO website or phone number included on the Contact List page. For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from HCSC or from any other person (including a primary care provider)
to obtain access to obstetrical or gynecological care from a health care professional in the 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 pre-approved treatment plan, or procedures for making referrals. For a list of participating health
care professionals who specialize in obstetrics or gynecology, refer to the appropriate HMO website or phone number on the Contact List page.
Every effort has been made to make this open enrollment guide as accurate and detailed as possible. However, legal documents known as the Summary Plan Descriptions (SPDs), which describe your benefit coverage, are also available. You may obtain a copy of the SPDs on myHR.
Patient Protection Notice