Required Legal Notifications
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998
On October 21, 1998 Congress passed a bill called the Women’s Health and Cancer Rights Act. This law requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. These services include:
- Reconstruction of the breast upon which the mastectomy has been performed,
- Surgery/reconstruction of the other breast to produce a symmetrical appearance,
- Prostheses, and
- Physical complications during all stages of mastectomy, including lymphedemas
In addition, the plan may not:
- interfere with a woman’s rights under the plan to avoid these requirements, or
- offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the requirements of the law.
However, the plan may apply deductibles and co-pays consistent with other coverage provided by the plan.
WOMEN’S PREVENTATIVE HEALTH BENEFIT EXPANDED
As a result of Healthcare Reform, all plans have been enhanced to include additional women’s preventative services including some of the following:
- Breast-feeding support, supplies and counseling
- Contraception methods and counseling*
- Domestic violence screening
- Gestational diabetes screening
- HIV screening and counseling
- HPV testing (beginning at age 30, and for every 3 years thereafter)
- Sexually transmitted infections counseling
- Well-woman visits
*Included under the contraception methods services are Tier 1 contraceptives at no cost to the member.
YOUNG ADULT OPTION
Effective September 1, 2009 New York passed a law that gives dependent children the right to continue medical coverage, up to age 30, after they reach the maximum child age in their parent’s policy (“Young Adult Option”). Under New York's Young Adult coverage option, the parent subscriber must be covered for the child to become or remain covered under this law. The child does not have to live with a parent, be financially dependent on a parent, or be a student to be covered. He or she must meet all the following criteria:
- Be less than 30 years of age;
- Be unmarried;
- Live, work or reside in New York state, or in the insurer's network service area for the plan;
- Not be eligible for coverage as participant of any other New York-insured or self-insured employee health plan; and
- Not be covered under Medicare.
Since the law became effective for policies that renewed on or after September 1, 2009, the Young Adult Option was added to Pace University’s medical plan effective July 1, 2010, which was the first contract renewal date after September 1, 2009. Dependent children can sign up for Young Adult coverage:
- during July 1, 2013 Open Enrollment period;
- within 60 days after reaching the maximum age or experiencing a qualifying life status change, as described in the parent’s plan;
- during any future Open Enrollment period held for the group plan.
If you have a dependent on COBRA because they aged off of the Pace University medical plan, he/she may elect this option at this time. Please keep in mind that once COBRA coverage is waived, it may not be reinstated.
Please note that Pace University’s dependent eligibility for the CIGNA medical plans is to the end of the calendar year in which the dependent turns age 26. Upon aging off the plan, the dependent will have the choice of the Young Adult Option or COBRA.
For those dependents aging off the plan that elect the Young Adult Option, it will provide an extension to coverage to age 30. Continuation will cease on the earliest of the following events:
- The dependent’s 30th birthday
- The dependent voluntarily terminates coverage
- The employee (insured) loses coverage
- The date the dependent become covered under another group plan*
- The date the dependent marries*
- The date on which a premium due is not paid
*A dependent who loses coverage and then regains eligibility by getting divorced, or losing other coverage may again apply for coverage. Thus, a dependent can go in and out of this continuation coverage as he or she loses coverage and then becomes eligible once again.
This extension coverage is to be paid for 100% by the dependent. Pace University will not contribute to the cost of the child’s premium. The premium for the Young Adult Option will be billed by and shall be paid directly to Pace University. As permitted by the law, CIGNA will charge 100% of the single subscriber or employee rate for each child enrolled in the Young Adult Option.
Pace University protects your individually identifiable health information. When you first became covered by our health plan you received a Privacy Notice that explains how we do that. A copy of the Privacy Notice is available to you on request and without charge. If you want a copy for any reason, just contact your Human Resource Manager.
NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS
A federal law called HIPAA requires that we notify you about a very important provision in the plan. The first is your right to enroll in the plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons.
Loss of Other Coverage- If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage or group health plan coverage, you may be able to enroll yourself and/or your dependents in this plan if you or your dependents lose eligibility for that other coverage or if the employer stops contributing towards your or your dependent’s coverage. You may be required to submit a signed statement that this other coverage was the reason for waiving enrollment originally. To be eligible for this special enrollment opportunity you must request enrollment within 30 days after your other coverage ends or after the employer stops contributing towards the other coverage.
New Dependent as a Result of Marriage, Birth, Adoption or Placement for Adoption- If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and/or your dependent(s). To be eligible for this special enrollment opportunity you must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.
Medicaid Coverage– Pace University health plans will allow an employee or dependent who is eligible, but not enrolled for coverage, to enroll for coverage if either of the following events occurs:
TERMINATION OF MEDICAID OR CHIP COVERAGE- If the employee or dependent is covered under a Medicaid plan or under a State child health plan (SCHIP) and coverage of the employee or dependent under such a plan is terminated as a result of loss of eligibility.
- ELIGIBILITY FOR PREMIUM ASSISTANCE UNDER MEDICAID OR CHIP- If the employee or dependent becomes eligible for premium assistance under Medicaid or SCHIP, including under any waiver or demonstration project conducted under or in relation to such a plan. This is usually a program where the state assists employed individuals with premium payment assistance for their employer’s group health plan rather than provide direct enrollment in a state Medicaid program.
To be eligible for this special enrollment opportunity you must request coverage under the group health plan within 60 days after the date the employee or dependent becomes eligible for premium assistance under Medicaid or SCHIP or the date you or your dependent’s Medicaid or state-sponsored CHIP coverage ends.
To request special enrollment or obtain more information, please contact Carolyn Ventura Lengers, Assistant Director, University Benefits at 914-923-2714.
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)
If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. Click here for more information.