HIPAA Notice of Special Enrollment Rights Premium Assistance Under Medicaid and If you are declining enrollment for yourself or your The Children’s Health Insurance Program dependents (including your spouse) because of other (CHIP) health insurance or group health plan coverage, you may If you or your children are eligible for Medicaid or be able to enroll yourself and your dependents in this CHIP and you’re eligible for health coverage from your plan if you or your dependents lose eligibility for that employer, your state may have a premium assistance other coverage (or if the employer stops contributing program that can help pay for coverage, using funds toward your or your dependents’ other coverage). from their Medicaid or CHIP programs. If you or your However, you must request enrollment within 30 days children aren’t eligible for Medicaid or CHIP, you won’t after your or your dependents’ other coverage ends (or be eligible for these premium assistance programs, but after the employer stops contributing toward the other you may be able to buy individual insurance coverage coverage). In addition, if you have a new dependent as through the Health Insurance Marketplace. For more a result of marriage, birth, adoption, or placement for information, visit www.healthcare.gov. adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment If you or your dependents are already enrolled in within 30 days after marriage. You must request Medicaid or CHIP and you live in a state listed in the CHIP enrollment within 60 days of birth, adoption, placement notice, contact your State Medicaid or CHIP of昀椀ce to 昀椀nd for adoption, loss of eligibility for Medicaid or Children’s out if premium assistance is available. Health Insurance Program (CHIP) or becomes eligible for If you or your dependents are NOT currently enrolled subsidy (state premium assistance program). To request in Medicaid or CHIP, and you think you or any of your special enrollment or obtain more information, contact dependents might be eligible for either of these UnityPoint Health’s AskHR department by calling 1-888- programs, contact your State Medicaid or CHIP of昀椀ce or 543-2275. dial 1(877) KIDS NOW or www.insurekidsnow.gov to 昀椀nd out how to apply. If you qualify, ask your state if it has a Women’s Health And Cancer Rights Act of program that might help you pay the premiums for an 1998 (WHCRA) employer-sponsored plan. If you or your dependents are eligible for premium Do you know that your plan, as required by the Women’s assistance under Medicaid or CHIP, as well as eligible Health and Cancer Rights Act of 1998, provides bene昀椀ts under your employer plan, your employer must allow for mastectomy-related services including all stages of you to enroll in your employer plan if you aren’t already reconstruction and surgery to achieve symmetry between enrolled. This is called a “special enrollment” opportunity, the breasts, prostheses, and complications resulting and you must request coverage within 60 days of being from a mastectomy, including lymphedema? Call determined eligible for premium assistance. If you have HealthPartners Member Services at (888) 735-9200 for questions about enrolling in your employer plan, contact more information. the Department of Labor at www.askebsa.dol.gov or call 1(866) 444-EBSA(3272). No Surprise Act Notice If you live in one of the states listed in the CHIP notice, Federal law requires health insurance issuers offering you may be eligible for assistance paying your employer group health insurance coverage to make available health plan premiums. Contact your state using the a notice to team members informing them of federal contact information provided here for more information restrictions on balance billing and the requirements on eligibility. under Code 9816, ERISA section 716, and PHS Act second 2799A-1. The No Surprise Act Notice also lets you know how you may contact appropriate state or federal agencies if a provider or facility has violated the restrictions against balance billing. | 49 |