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06-G HIPAA and PHA Opt-Out
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06-G HIPAA and PHA Opt-Out
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Last modified
9/12/2012 10:31:40 AM
Creation date
3/4/2002 7:30:19 PM
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AGENDA
Item Number
6-G
AGENDA - Type
RESOLUTION
Description
HIPAA and PHS Opt-Out
AGENDA - Date
3/11/2002
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NOTICE TO PLAN PARTICIPANTS REGARDING THE CITY OF PARIS'S <br />ELECTION UNDER 42 U.S.C 300 gg-21 <br />THIS IS TO NOTIFY YOU THAT FEDERAI, LAW IIvIPOSES UPON GROUP HEALTH PLANS CERTAIN <br />LIIvIITATIONS OF PREEXISTING CONDITION EXCLUSION PERIODS. SPECIAL ENROLLMENT PERIODS FOR <br />INDIVIDUALS (AND DEPENDENTS) LOSING OTHER COVERAGE, PROHIBITIONS AGAINST DISCRIIvIINATING <br />AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS, STANDARDS <br />RELATING TO BENEFITS FOR MOTHERS AND NEWBORNS, AND PARITY IN THE APPLICATION OF CERTAIN <br />LIIvIITS TO MENTAL HEALTH BENEFITS AND A WOMAN'S RIGHT TO TREATMENT OF THE UNAFFECTED <br />BREAST FOLLOWING A MASTECTOMY. FEDERAI, LAW ALLOWS A NON-FEDERAI, GOVERNMENTAL PLAN <br />(SUCH AS THE CITY OF PARIS'S PLAN) TO EXEMPT ITS PLAN IN WHOLE OR IN PART FROM THESE <br />REOLIIREMENTS. THE CITY OF PARIS HAS ELECTED TO BE EXEMPT FROM THE FOLLOWING <br />REOLIIREMENTS: LIMITATIONS ON PREEXISTING CONDITION EXCLUSION PERIODS, SPECIAL <br />ENROLLMENT PERIODS FOR INDIVIDUALS (AND DEPENDENTS) LOSING COVERAGE, PROHIBITIONS <br />AGAINST DISCRIIvIINATING AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH <br />STATUS, STANDARDS RELATING TO BENEFITS FOR MOTHERS AND NEWBORNS, AND THE PARITY IN THE <br />APPLICATION OF CERTAIN LIIvIITS TO MENTAL HEALTH BENEFITS. BECAUSE OF THIS ELECTION <br />EMPLOYEES AND DEPENDENTS WII,L BE SUB7ECT TO BENEFIT LIIvIITS EVEN IF THEY HAD 12 OR 18 <br />MONTHS OF COVERAGE LJNDER ANOTHER PLAN WITHIN THE LAST 63 DAYS, THE DLJRATION OF A <br />HOSPITAL CONFINEMENT FOR A MOTHER AND NEWBORN FOLLOWING THE BIRTH OF A CHII,D WII,L BE <br />DETERMIINED ON MEDICAL NECESSITY, AND MENTAL HEALTH BENEFITS HAVE AN ANNTJAL MAXIIvILJM <br />WHICH IS LESS THAN THE MAXIIvILJMS FOR OTHER MEDICAL CONDITION. EVEN THOUGH THE PLAN IS <br />EXEMPT, EMPLOYEES AND DEPENDENTS WII,L BE ABLE TO ENROLL IF THEY HAVE A OUALIFYING <br />EVENT DLJRING THE PLAN YEAR AS SET FORTH IN THIS BOOKLET AND NO INDIVIDUAL WII,L BE <br />DECLINED COVERAGE OR CHARGED A HIGHER RATE BASED ON A MEDICAL CONDITION. THE PLANS <br />OUALIFYING EVENTS ARE MORE LIBERAI, THAN THE FEDERAI, LAW. THE ENTIRE PLAN IS SUB7ECT TO <br />THIS EXEMPTION. <br />
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