Page 22 - SunWest EE Guide 09-19 Outside CA

Annual ACA

Notices The Affordable Care Act (ACA) requires

applicable large employers to make
affordable coverage available to their
employees or risk paying a penalty. Although

Sun West plans are partially arranged by Sun West and the individual mandate is no longer effective
beginning January 1, 2019, it is important
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 its plan insurance coverage. You may consider these
participants. Sun West distributes annual notices to new- options below:
hires, and each year during open enrollment. You may also  Enroll in a medical plan offered by Sun
request a copy by contacting the Human Resources West or another group plan
Department, or download a copy from ADP.  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 Sun West’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 Sun West’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 For More Information
newborn child are covered for a hospital stay following Go to www.healthcare.gov.
childbirth.
 Special Enrollment Rights: Plan participants are
entitled to certain special enrollment rights outside of
Sun West’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.

22 Employee Benefits