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Please Read
Mother’s Health Protection Act
Group health plans and health insurance issuers
generally may not, under Federal law, 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 caesarean section. However, Federal law
generally does not prohibit the mother’s or newborn’s
attending provider, after 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 issuer
for prescribing a length of stay not in excess of 48 hours
(or 96 hours). 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.
It is the employee’s responsibility
to notify the Human Resources Department of their
pregnancy so they can be provided their statement of
rights under the Newborn’s and Mother’s Health
Protection Act.
Women’s Health and Cancer Rights Act
Special Rights Following Mastectomy. A group health
plan generally must, under federal law, make certain
benefits available to participants who have undergone a
mastectomy. In particular, a plan must offer
mastectomy patients benefits for:
Reconstruction of the breast on which the
mastectomy has been performed;
Surgery and reconstruction of the other breast to
produce a symmetrical appearance;
Prostheses; and
Treatment of physical complications of mastectomy.
Our Plan complies with these requirements. Benefits for
these items generally are comparable to those provided
under our Plan for similar types of medical services and
supplies. Of course, the extent to which any of these
items is appropriate following mastectomy is a matter to
be determined by consultation between the attending
physician and the patient. Our Plan neither imposes
penalties (for example, reducing or limiting
reimbursements) nor provides incentives to induce
attending providers to provide care inconsistent with
these requirements.
Patient Protection and Affordable Care Act
BlueCross BlueShield generally allows the
designation of a primary care provider. You have
the right to designate any primary care provider
who participates in your chosen network and who
is available to accept you or your family
members.
For children you may designate a pediatrician as
the primary care provider.
You do no need prior authorization from
BlueCross BlueShield 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 the network
who specializes in obstetrics or gynecology. The
health care professional, however, may be
required to comply with certain procedures,
including obtaining prior authorization for certain
services, following pre-approved treatment plans
or procedures for making referrals. For a list of
participation health care professionals who
specialize in obstetrics or gynecology, contact
your Human Resources department at the phone
number on the contact list included in this packet
for more information.
HIPAA Special Enrollment Notice
If you are declining enrollment for yourself or
your dependents (including your spouse)
because of other health insurance or group
health plan coverage, you may be able to enroll
yourself or your dependents in this plan if you or
your dependents lose eligibility for that other
coverage (or if the employer stops contributing
towards you or your dependents’ other
coverage). However, you must request
enrollment within 30 days after you or your
dependents’ other coverage ends (or after the
employer stops contributing toward the other
coverage).
In addition, if you have a new dependent as
result of marriage, birth, adoption, or placement
for adoption, you may be able to enroll yourself
and your dependents. However, you must
request enrollment within 30 days after the
marriage, birth, adoption or placement for
adoption.
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Annual Notices