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January 13, 2003 <br /> <br />HCFA <br />Attn: David Holstein <br />7500 Security Blvd. Room S-L17 <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 <br />Year beginning October 1, 1999. <br /> <br />Limitations on pre-existing condition exclusion periods (146.111); <br />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 />Prohibitions against discriminating against individual participants and <br />beneficiaries based on health status (146.121); <br />Standards relating to benefits for mothers and newborns (section 2704 of the PHS <br />Act); <br />Parity in the application of certain limits to mental health benefits. <br />Benefits relating to women's health and cancer rights (section 903 of the PHS <br />Act). 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 />EXHIBIT A <br /> <br /> <br />