Page 29 - Confie Benefits Guide

Important Notices (continued)

Keep your Plan informed of address changes Women’s Health & Cancer Rights Act (WHCRA)
To protect your family’s rights, let the Plan Administrator know about If you have had or are going to have a mastectomy, you may be entitled
any changes in the addresses of family members. You should also keep a to certain benefits under the Women’s Health and Cancer Rights Act of
copy, for your records, of any notices you send to the Plan 1998 (WHCRA). For individuals receiving mastectomy-related benefits,
Administrator. coverage will be provided in a manner determined in consultation with
the attending physician and the patient, for:
Plan contact information •
Confie Seguros Holding II Co. All states of reconstruction of the breast on which the mastectomy
Human Resources Department • was performed;
7711 Center Drive, 2nd Floor Surgery and reconstruction of the other breast to produce a
Huntington Beach, CA 92647 symmetrical appearance;
714-252-2612 • Prostheses; and
Benefits@confie.com • Treatment of physical complications of the mastectomy, including
lymphedema.

These benefits will be provided subject to the same deductibles and
HIPAA Special Enrollment Notice
coinsurance applicable to other medical and surgical benefits provided
If you are declining enrollment for yourself or your dependents
(including your spouse) because of other health insurance or group under the medical plan.
health plan coverage, you may be able to enroll yourself or your
dependents in this plan if you or your dependents lose eligibility for that To obtain more information on WHCRA benefits, please contact 7711
other coverage (or if the employer stops contributing towards your or Center Drive, 2nd Floor, Huntington Beach, CA 92647; telephone: 714-
your dependents’ other coverage). However, you must request 252-2612; email: benefits@confie.com.
enrollment within 30 days after your or your dependents’ other
coverage ends (or after the employer stops contributing toward the Newborn and Mother’s Health Protection Act
other coverage). Group health plans and health insurance issuers generally may not,
under Federal law, restrict benefits for any hospital length of stay in
In addition, if you have a new dependent as result of marriage, birth,
connection with childbirth for the mother or newborn child to less than
adoption, or placement for adoption, you may be able to enroll yourself
48 hours following a vaginal delivery, or less than 96 hours following a
and your dependents. However, you must request enrollment within 30
cesarean section. However, Federal law generally does not prohibit the
days after the marriage, birth, adoption, or placement for adoption.
mother’s or newborn’s attending provider, after consulting with the
Special enrollment rights also may exist in the following circumstances: mother, from discharging the mother or her newborn earlier than 48

• If you or your dependents experience a loss of eligibility for hours (or 96 hours as applicable). In any case, plans and issuers may not,
under Federal law, require that a provider obtain authorization from the
Medicaid or a state Children’s Health Insurance Program (CHIP)
plan or the insurance issuer for prescribing a length of stay not in excess
coverage and you request enrollment within 60 days after that
of 48 hours (or 96 hours).
coverage ends; or
• If you or your dependents become eligible for a state premium To obtain more information, please call or email the contact listed on the
assistance subsidy through Medicaid or a state CHIP with respect to cover of this document.
coverage under this plan and you request enrollment within 60 days
after the determination of eligibility for such assistance.

Note: The 60 day period for requesting enrollment applies only in these
last two listed circumstances relating to Medicaid and state CHIP. As
described above, a 30 days period applies to most special enrollments.
To request special enrollment or obtain more information, contact 7711
Center Drive, 2nd Floor, Huntington Beach, CA 92647; telephone: 714-
252-2612; email: benefits@confie.com.

Genetic Information Nondiscrimination Act (GINA)
The Equal Employment Opportunity Commission (EEOC) has issued final
regulations implementing Title II of the Genetic Information
Nondiscrimination Act (GINA). Title II generally prohibits employment
discrimination based on genetic information, as well as collection, use
and disclosure of genetic information in connection with employment.
President Bush signed GINA into law in May 2008 and it is currently in
effect. The EEOC’s new regulations are effective January 10, 2011, and
employers may want to implement some compliance measures in
response to the regulations.

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