Profisee 2018 Benefit Guide

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The date that Plan coverage would

otherwise

terminate (for reasons other than

failure to be a full-time student)

A dependent child on a medically necessary leave of absence is entitled to receive the

same Plan benefits as other dependent children covered under the Plan. Further, any

change to Plan coverage that occurs during the Michelle’s Law extension of eligibility

will apply to the dependent child to the same extent as it applies to other dependent

children covered under the Plan.



Patient Protection Model Disclosure

Medical plans generally allow the designation of a primary care provider. You have the

right to designate any primary care provider who participates in the network and who is

available to accept new members. For children, a pediatrician can be selected as the

primary care provider.

Profisee Group, Inc. believes this medical plan is a “grandmothered health plan” under the

Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the

Affordable Care Act, a grandmothered health plan can preserve certain basic health

coverage that was already in effect when that law was enacted. Being a grandmothered

health plan means that your plan may not include certain consumer protections of the

Affordable Care Act that apply to other plans, for example, the requirement for the

provision of preventive health services without any cost sharing. However, grandmothered

health plans must comply with certain other consumer protections in the Affordable Care

Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a

grandmothered health plan and what might cause a plan to change from grandmothered

health plan status can be directed to the plan administrator at 678-202-8911. You may

also contact the Employee Benefits Security Administration, U.S. Department of Labor at

1-866-444-3272 or

This website has a table summarizing

which protections do and do not apply to grandfathered health plans.

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Grandmothered Health Plan Notification