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Statement of Rights under the 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 assis-
tant), 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 au-
thorization 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 prior authorization or notify the Claims Administrator.
For information on notification or prior authorization, contact your issuer.
Women’s Health and Cancer Rights Act Notice
If you have had or are going to have a mastectomy, you may be entitled to certain benefits
under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving
mastectomy-related benefits, coverage will be provided in a manner determined in consultation
with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to
other medical and surgical benefits provided under this plan. Contact your Human Resources Representative for more
information.
For more information about Medicare prescription drug coverage:
• Visit
www.medicare.gov• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare
& You” handbook for their telephone number) for personalized help
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available.
For information about this extra help, visit Social Security on the web at
www.socialsecurity.gov ,or call them at 1-
800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans,
you may be required to provide a copy of this notice when you join to show whether or not you have
maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium
(a penalty).
Date July 1, 2017
Contact: Human Resources
Address: 651 Corporate Circle, Suite 123
Golden, CO 80401
Phone: (303) 277-0066
Medicare Part D Notice
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B E N E F I T S P L A N O V E R V I E W