Page 28 - GBS OE Brochure - Generic Hospitality

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ABC COMPANY | HOSPITALITY
2017 OPEN ENROLLMENT
with childbirth for the mother or newborn child to less than
48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (e.g., your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier.
Set the level of bene ts or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay.
Require that you, your physician, or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, you may be required to obtain precerti cation for any days of con nement that exceeds 48 hours (or 96 hours).
For information on precerti cation, please refer to the Bene t Summaries.
Special Enrollment
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in the plan, provided that your request enrollment within 30 days after your other coverage ends (COBRA or state continuation coverage ends, divorce, legal separation, death, termination of employment or reduction in hours worked; or because the employer contributions cease). In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.
If you or your dependent lose coverage under a Medicaid Plan or Children’s Health Insurance Program (CHIP), or become eligible for group health plan premium assistance under a Medicaid Plan or under the CHIP, you may request enrollment within 60 days after coverage under the Medicaid or CHIP ends or within 60 after you or your dependent is determined to be eligible for state premium assistance under CHIP.
HIPAA Notice of Privacy Practices
Health Insurance Portability and Accountability Act (HIPAA) privacy rules require that Health Plans distribute a notice to participants of their privacy rights. This notice was provided to you upon your enrollment in the plan. You may also request a hard copy by contacting Human Resources.
This Enrollment Guide represents a Summary of Material Modi cations to the existing Summary Plan Descriptions.
In addition, this Guide highlights certain provisions of the welfare bene t plans available to eligible employees (and dependents and/or bene ciaries) effective August 1, 2017. Complete details are in the respective Summary Plan Descriptions and plan documents. In case of a con ict between the information in this Enrollment Guide and the wording in either the of cial plan documents or Summary Plan Descriptions, the plan documents and/or Summary
Plan Descriptions always govern. The Company expects to continue these plans inde nitely but reserves the right to terminate, suspend, withdraw, amend or modify them at any time without prior notice to participants to the extent permitted by law. Any change, termination of bene ts or increase in costs to participants will be based solely on the decision of the Company and may apply to active employees, employees on leave of absence, and former employees with coverage through COBRA. In addition, the tax treatment of these bene ts is subject to change without notice, as determined by federal, state or local tax authorities.