Required Legal Notifications
Loss of Grandfathered Status/Dependents to Age 26
Pace’s plan will no longer be considered “grandfathered” under healthcare reform. Last year, we incorporated many of the provisions that non-grandfathered plans were required to provide. One last change that we incorporated this year impacted dependents under age 26. Pace’s plan will allow all dependents under age 26 to enroll in the medical plan regardless of whether or not the dependent has access to his/her own employer’s healthcare coverage.
Women’s Health and Cancer Rights Act of 1998
The Women’s Health and Cancer Rights Act of 1998 mandates coverage for breast reconstruction after a mastectomy. While medical plan carriers are required by federal law to notify participants on an annual basis about this coverage, Pace University is also taking this opportunity to remind you that this coverage is available under our health plans:
The medical plans offered at Pace University provide benefits for mastectomy related services, including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from mastectomy (including lymphedema).
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.
Please contact CIGNA for further information.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses the privacy of an individual’s identifiable health information. Protected health information (PHI) is defined as information about you, which is maintained by Pace University, and is required to perform certain health care operations such as eligibility determination, enrollment, payment of premiums, and payment of claims on your behalf.
Any protected health information received by the University Benefits office, or by a member of Human Resources, is handled in a confidential manner. Please click here for more information about the Privacy Notice, procedures and frequently asked questions.
Changes in Family Status
Loss of Other Coverage
If you are declining enrollment for yourself and/or your dependents (including your spouse/domestic partner) 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. You will be required to submit documentation to support this event. To be eligible, you must enroll within 31 days after your coverage ends.
New Dependent as a Result of Marriage, Birth, Adoption or Domestic Partnership Approval
If you have a new dependent as a result of marriage, birth, adoption or a domestic partnership, you may be able to enroll yourself and/or your dependent(s). You will be required to submit documentation to support this event. To be eligible for this special enrollment opportunity, you must enroll within 31 days after the marriage, birth, adoption or domestic partnership approval.
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, 2012 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, they 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 will be until age 26, with coverage until the end of the calendar year. Upon aging off the plan, the dependent will have the option 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. 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.
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
Pace University’s group health plan will allow an employee or dependent who is eligible, but not enrolled for coverage, to enroll for coverage if either of the following events occur:
1. Eligibility for Employment Assistance under Medicare or CHIP
2. Termination of Medicaid of Children’s Health Insurance Program (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.
To request special enrollment or obtain more information, please contact the University Benefits office at (914) 923-2828 or email@example.com.
Click here to view the list of States current as of January 31, 2012. You should contact your State for further information on eligibility.