Page 10 - ABC Company Burnham Sample Guide

The Affordable Care Act (ACA) requires
applicable large employers to make
affordable coverage available to their
employees or risk paying a penalty. Although

ABC Company plans are partially arranged by ABC Company the individual mandate is no longer effective
beginning January 1, 2019, it is important
and governed by it’s plan rules and documents. ERISA and
various other state and federal laws require that employers that you understand your options for health
provide disclosure and annual notices to their plan insurance coverage. You may consider these
participants. ABC Company distributes annual notices to options below:
new-hires, and each year during open enrollment. You may • Enroll in a medical plan offered by ABC
also request a copy by contacting the Human Resources Company or another group plan
Department, or download a copy from Ease. • Purchase coverage through a health
insurance marketplace
The following are a list of Annual Notices: • Enroll in coverage through a government
• Medicare Part D Notice of Creditable Coverage: Plans -sponsored program if eligible
are required to provide each covered participant and
dependent a Certificate of Creditable Coverage to qualify Because ABC Company’s medical plans are
for enrollment in Medicare Part D prescription drug considered affordable and meet minimum
coverage when qualified without a penalty. value under the Affordable Care Act, you will
• HIPAA Notice of Privacy Practices: This notice is not generally see lower premiums or out-of-
intended to inform employees of the privacy practices pocket costs through the marketplace. In
followed by ABC Company’s group health plan. It also addition, employer contributions to your
explains the federal privacy rights afforded to you and medical benefits will be lost if you choose to
the members of your family as plan participants covered purchase coverage through the marketplace,
under a group plan. and your portion of medical premiums will
• Women's Health and Cancer Rights Act (WHCRA): This no longer be paid via payroll deductions on a
act contains important protections for breast cancer pre-tax basis.
patients who choose breast reconstruction with a
mastectomy.
• Newborns’ and Mothers’ Health Protection Act: This
act affects the amount of time a mother and her
newborn child are covered for a hospital stay following For More Information
childbirth. Go to www.healthcare.gov.
• Special Enrollment Rights: Plan participants are
entitled to certain special enrollment rights outside of
ABC Company’s open enrollment period. This notice
provides information on special enrollment periods for
loss of prior coverage or the addition of a new
dependent.
• Medicaid & Children’s Health Insurance Program:
Some states offer premium assistance programs for
those who are eligible for health coverage from their
employers, but are unable to afford the premiums. This
notice provides information on how to determine if your
state offers a premium assistance program.
• Summary of Benefits and Coverage (SBC): Health
insurance issuers and group health plans are required to
provide you with an easy-to-understand summary about
your health plan’s benefits and coverage.