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<br />~ <br /> <br /> <br />r-j~ CQ!L~~ (QJ~% ~~~tJl~ <br /> <br />~ <br /> <br />January 13,2003 <br /> <br />HCFA <br />Attn: David Holstein <br />7500 Security Blvd. Room S-Ll7 <br />Baltimore, MD 21244-1850 <br /> <br />RE: Election to be exempted from certain requirements under HIPAA <br /> <br />Dear Mr. Holstein: <br /> <br />The City of Paris elects that its group medical plan be exempted from the following <br />requirements of the Health Insurance Portability and Accountability Act of 1996 for the Plan Year <br />beginning October 1, 1999. <br /> <br />1. Limitations on pre-existing condition exclusion periods (146.111); <br />2. Special enrollment periods for individuals (and dependents) losing other coverage <br />and special enrollment periods with respect to certain dependent beneficiaries <br />(146.117); <br />3. Prohibitions against discriminating against individual participants and beneficiaries <br />based on health status (146.121); <br />4. Standards relating to benefits for mothers and newborns (section 2704 of the PHS <br />Act); <br />5. Parity in the application of certain limits to mental health benefits. <br />6. Benefits relating to women's health and cancer rights (section 903 of the PHS Act). <br />Treatment or reduction of the non-affected breast following a mastectomy. <br /> <br />The medical benefits payable by the City's health plan are self-funded. The plan is <br />protected against catastrophic loss by aggregate and individual stop loss policies (which do not <br />prevent an election under Sec. 146.180(3) of 45 C.F.R. Part 16 of the Federal Regulations) that <br />reimburse the City for medical claims paid in excess of stop loss levels. <br /> <br />The City of Paris's group medical plan is identified as follows: <br /> <br />Name of Plan: <br />Plan Sponsor: <br />Plan Manager: <br /> <br />City of Paris, Texas Intergovernmental Employee Benefits Pool <br />City of Paris <br />W. E. Anderson <br /> <br />P.O, BOX 9037 . PARIS, TEXAS 75461.9037 . (903) 765.7511 . FAX (903) 765.8519 <br /> <br />EXHIBIT A- <br />