25 LEGAL NOTICES I BENEFITS GUIDE LEGAL NOTICES Health Insurance Portability and Accountability Act of 1996 (HIPAA) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that addresses the privacy and secur ity of certain individually identifiable health information, called protected health information (or PHI). You have certain rights w ith respect to your PHI, including a right to see or get a copy of your health and claims records and other health information maintained by a health plan or carrier. For a copy of the Notice of Privacy Practices, describing how your PHI may be used and disclosed and how you ge t access to the information, contact Human Resources. Women’s Health and Cancer Rights Act Enrollment Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Woman’s Health and Cance r Rights Act of 1998 (WHCRA). For individuals receiving mastectomy - related benefits, coverage will be provided in a manner determi ned in consultation with the attending physician and the patient, for: 1. All stages of reconstruction of the breast on which mastectomy was performed. 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses. 3. Treatment of physical complications of the mastectomy, including lymphedema. These will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits prov ide d under this benefits plan. Therefore, the following deductibles and coinsurance apply: [insert medical deductibles and coinsurance applicable to these benefits ]. If you would like more information on WHCRA benefits, call your plan administrator at 646 - 300 - 7016. Newborns’ and Mothers’ Health Protection Act Disclosure Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital leng th of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 9 6 h ours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, aft er 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 iss uer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Patient Protection Notice Your carrier generally may require the designation of a primary care provider. You have the right to designate any primary c are provider who participates in your network and who is available to accept you or your family members. Until you make this des ign ation, your carrier may designate one for you. For information on how to select a primary care provider, and for a list of the parti cip ating primary care providers, contact the [plan administrator or carrier] at [insert contact information]. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from your c arr ier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in your network who specializes in obstetrics or gynecology. The health care professional, however, may be re quired to comply with certain procedures, including obtaining prior authorization for certain services, following a pre - approved treatm ent plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gyn eco logy, contact the [plan administrator or carrier] at [insert contact information].