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382 A x f : F P�A�RI S �I _} gg Al ..- ;rr nl � :s -� � � i� .. � .....�.,.,x..... •� �.r.. +....... ��: � � .....\ �m�avmw.��`.x...,... January 13, 2003 HCFA Attn: David Holstein 7500 Security Blvd. Room S -L17 Baltimore, MD 21244 -1850 RE. Election to be exempted from certain requirements under HIPAA Dear Mr. Holstein: The City of Paris elects that its group medical plan be exempted from the following requirements of the Health Insurance Portability and Accountability Act of 1996 for the Plan Year beginning October 1, 1999. 1. Limitations on pre- existing condition exclusion periods (146.111); 2. Special enrollment periods for individuals (and dependents) losing other coverage and special enrollment periods with respect to certain dependent beneficiaries (146.117); 3. Prohibitions against discriminating against individual participants and beneficiaries based on health status (146.121); 4. Standards relating to benefits for mothers and newborns (section 2704 of the PHS Act); 5. Parity in the application of certain limits to mental health benefits. 6. Benefits relating to women's health and cancer rights (section 903 of the PHS Act). Treatment or reduction of the non - affected breast following a mastectomy. The medical benefits payable by the City's health plan are self - funded. The plan is protected against catastrophic loss by aggregate and individual stop loss policies (which do not prevent an election under Sec. 146.180(3) of 45 C.F.R. Part 16 of the Federal Regulations) that reimburse the City for medical claims paid in excess of stop loss levels. The City of Paris's group medical plan is identified as follows: Name of Plan: City of Paris, Texas Intergovernmental Employee Benefits Pool Plan Sponsor: City of Paris Plan Manager: W. E. Anderson P.O. BOX 9037 + PARIS. TEXAS 75461 -9037 • (903) 785 -7511 • FAX (903) 785 -8519 EXHIBIT A-