Page 25 - Kate Somerville Benefits Guide 2020 CA FINAL

Important Notices & 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 em-
ployees, employee’s dependents and, as applicable, retired employees. The Notice describes that ABC Company may use and disclose Pro-
tected 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 main-
tain 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 Pro-
tected 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:
Corporate Headquarters
2121 Park Pl, 1st Floor
El Segundo, CA 90245

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
Aetna 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,
Aetna 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 Aetna HMO at 888-256-1915
For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from Aetna 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 ser-
vices, 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 Aetma HMO at (800) 445-5299.

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 cover-
age, 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.

KATE SOMERVILLE EMPLOYEE BENEFITS 25