FOR YOUR INFORMATION
Important Notices
Special Enrollment Notice
During the open enrollment period, eligible employees are given the opportunity to enroll themselves and dependents into our group health plans. If you elect to decline coverage because you are covered under an individual health plan or a group health plan through your parent ’ s or spouse ’ s employer, you may be able to enroll yourself and your dependents in this plan if you and/or your dependents lose eligibility for that other coverage. If coverage is lost, you must request enrollment within 30 days after the other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may enroll any new dependent within 30 days of the event. To request special enrollment or obtain more information, contact the Business Office at extension 6024. Women ’ s Health and Cancer Rights Act of 1998 As a requirement of the Women ’ s Health and Cancer Rights Act of 1998, your plan provides benefits for mastectomy - related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema. The benefits must be provided and are subject to the health plan ’ s regular co - pays, deductibles, and co - insurance. You may contact our health carrier at the phone number on the back of your ID card for additional benefit information.
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, call the member phone number on your health plan ID card.
COBRA Continuation Rights Under Federal Law
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage plus a 2% administrative fee. Please contact the School District of Clayton ’ s Business Office for additional information.
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