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Important Legal Notices HIPAA Privacy Notice Reminder Woman's Health and Cancer Rights Act of 1998 The health plans offered by School District of Indian River County are If you have had or are going to have a mastectomy,you may required by the Health Insurance Portability and Accountability Act of be entitled to certain benefits under the Women's Health 1996 (HIPAA) Privacy Rule to maintain the privacy of your health and Cancer Rights Act of 1998 (WHCRA). For individuals information.The Notices of Privacy Practices for our Health plans are receiving mastectomy-related benefits, coverage will be available from the insurance carriers;in addition,you may also request provided in a manner determined in consultation with the a copy of a Notice by calling your insurance provider. Be assured attending physician and the patient,for: School District of Indian River County and our insurance carriers fully • All stages of reconstruction of the breast on which the comply with this requirement. mastectomy was performed; Note: Because this reminder is required by law, you will receive • Surgery and reconstruction of the other breast to separate reminders from each of the insurance plans in which you produce a symmetrical appearance; enroll as well as other providers describing the availability of their HIPAA notice of privacy practices and how to obtain a copy. • Prostheses;and • Treatment of physical complications of the mastectomy, HIPAA Special Enrollment Opportunity including lymphedema. If you are declining enrollment for yourself or your dependents These benefits will be provided subject to the same (including your spouse) because of other health insurance or group deductibles and coinsurance applicable to other medical and health plan coverage, you may be able to enroll yourself and your surgical benefits provided under the group medical plan. dependents in this plan if you or your dependents lose eligibility for Summary of Benefits and Coverage (SBC) that other coverage(or if the employer stops contributing toward your Availability Notice or your dependents' other coverage). However, you must request enrollment within 30 days after your or your dependents' other As required under the Patient Protection and Affordable coverage ends (or after the employer stops contributing toward the Care Act, insurance companies and group health plans are other coverage). providing consumers with a concise document detailing, in In addition,if you have a new dependent as a result of marriage,birth, plain language, simple and consistent information about health plan benefits and coverage. The purpose of the adoption, or placement for adoption, you may be able to enroll summary of benefits and coverage document is to help you yourself and your dependents.However,you must request enrollment better understand the coverage you have while allowing you within 30 days after the marriage, birth, adoption, or placement for to easily compare different coverage options. It summarizes adoption. the key features of the plan, such as the covered benefits, Also, if you or your dependents lose eligibility for coverage under cost-sharing provisions, and coverage limitations and Medicaid or the Children's Health Insurance Program (CHIP) or exceptions. become eligible for a premium assistance subsidy under Medicaid or As a result of the Patient Protection and Affordable Care Act CHIP, you may be able to enroll yourself and your dependents in this (i.e. health care reform), School District of Indian River plan. You must request enrollment within 60 days of the loss of County is required to make available a Summary of Benefits Medicaid or CHIP coverage or the determination of eligibility for a and Coverage (SBC), which summarizes important health premium assistance subsidy. plan information such as plan limits, coinsurance, and To request special enrollment or obtain more information, contact copays.The SBC is intended to provide this information in a Florida Blue at 800-545-6565 ext.25305. standard format to help you compare across health plan A federal law called HIPAA requires that we notify your right to enroll options. in the plan under its "special enrollment provision" if you acquire a The SBC is available on the School District of Indian River new dependent,or if you decline coverage under this plan for yourself County's Benefit Landing Page: or an eligible dependent while other coverage is in effect and later lose http://www.explainmybenefits.com/sdirc/ that other coverage for certain qualifying reasons. Newborns'and Mothers'Health Protection Act of 1996 Please note that an SBC is not intended to be a complete Group health plans and health insurance issuers generally may not, listing of all of the plan provisions. For more detailed under Federal law, restrict benefits for any hospital length of stay in information,please refer to the SPD and the plan document, connection with childbirth for the mother or newborn child to less collectively known as the plan documents. If there are any than 48 hours following a vaginal delivery, or less than 96 hours discrepancies between the SBC and the plan documents,the following a cesarean section. plan documents prevail. Plan Documents are also available by contacting the Employee Benefits Department. Federal law generally does not prohibit the mother's or newborn's attending provider,after consulting with the mother,from discharging the mother or her newborn earlier than 48 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 plan or the insurance issuer for prescribing a length of stay not in excess of 48 67 32hours(or 96 hours).