Page 11 - 2019 Point Loma Credit Union Benefits Guide

Other Important Notices and Disclosures

The Women’s Health and Cancer Rights Act of 1998—Important Notice
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act.
Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a
mastectomy is also entitled to the following benefits:
Reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prosthesis and treatment of physical complications in all stages of mastectomy, including lymphedemas.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction
and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
HIPAA Privacy Notice—Important Notice about Your Health Information
The HIPAA Notice of Privacy Practices applies to Protected Health Information associated with the Group Health plan provided to our employees,
employee’s dependents and, as applicable, retired employees. The Notice describes that Point Loma Credit Union may use and disclose Protected
Health Information to carry out payment and health care operations, and for other purposes that are permitted or required by law.
We are required by the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to maintain the
privacy of Protected Health Information and to provide individuals covered under our group health plan with notice of our legal duties and privacy
practices concerning Protected Health Information. We are required to abide by the terms of the Notice so long as it remains in effect. We reserve the
right to change the terms of the Notice as necessary and to make the new Notice effective for all Protected health Information maintained by us. If we
make material changes to our privacy practices, copies of revised notices will be mailed to all policyholders then covered by the Group Health plan.
Copies of our current Notice may be obtained by contacting:
Janet Mainenti—Vice President of Human Resources
Phone: (858) 268-7216
Email: jmainenti@plcu.com

Newborns' and Mothers Health Protection Act
Under federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any
hospital length of stay in connection 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.
Also, under federal law, plans and issuers may not set the level of benefits 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.
In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length
of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to
obtain precertification. For information on precertification, contact your plan administrator.
Patient Protection Disclosure
Kaiser Permanente HMO health plan generally requires/allows the designation of a primary care provider. You have the right to designate any primary
care provider who participates in our network and who is available to accept you or your family members. Until you make this designation, Kaiser
Permanente designates one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers,
contact Kaiser Permanente HMO at 800-464-4000
For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from Kaiser Permanente 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 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 HMO at 800-464-4000.
HIPAA Special Enrollment Rights
If you are declining for yourself or your dependent (including your spouse) because of other health insurance or group health plan coverage, you may be
able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops
contributing towards you or your dependent’s other coverage). However, you must request enrollment within 30 days after your or your dependent’s
other coverage ends (or after the employer stops contributing towards the other coverage). Note: if the change is due to Medicaid/CHIP eligibility, there
is a 60 day window for Medicaid/CHIP eligibility changes only.

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