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2005-038-RES ELECTING EXEMPTION FROM THE REQUIREMENTS OF HIPAA AND THE PUBLIC HEALTH SERVICE ACT RESOLUTION NO. 2005-03R A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS, PARIS, TEXAS, ELECTING, PURSUANT TO 42 U.S.C. SEC. 300GG-21, EXEMPTION FROM THE REQUIREMENTS OF THE HEALTH INSURANCE PORT ABILITY AND ACCOUNT ABILITY ACT (HIP AA) AND THE PUBLIC HEALTH SERVICES ACT (PHS); AUTHORIZING THE EXECUTION OF THE NECESSARY ELECTION AND NOTICE FORMS UNDER 42 U.S.C. SEC. 300GG-21j MAKING OTHER FINDINGS AND PROVISIONS RELATED TO THE SUBJECTj AND PROVIDING AN EFFECTIVE DATE. WHEREAS, the City of Paris has a uniform group benefits plan that is administered by the exas Municipal League Intergovernmental Employee Benefits Pool (TML-IEBP); and, WHEREAS, effective with the first plan year following July 1,1997, the Federal Health nsurance Portability and Accountability Act of 1996 (HIPAA), which establishes a standard efinition for what can be considered an existing condition, went into effect, with the effective date or the City of Paris being May 1,1998; and, WHEREAS, in addition to HIP AA, the Federal Government has amended the Public Health ervices Act (PHS) to standardize benefits relating to mothers and newborns, to establish parity in e application of mental health benefits, and to address women's health and cancer rights; and, WHEREAS, the City of Paris's employee health benefit plan is a non-Federal governmental lan, and HIP AA allows such plans to elect to be exempt from any or all of this legislation; and, WHEREAS, the City Council of the City of Paris has acted to approved such exemptions n the past; and, WHEREAS, because of the severe penalties which are established in the law for non- ompliance, the City's plan administrator, TML-IEBP, recommends that the City of Paris continue o exempt itself to avoid the potential of financial penalties, and it is deemed appropriate that such ecommendation be taken; and, WHEREAS, the forms for the election and notice to enrollees under 42 U.S.C. Sec. 300gg- 1, attached hereto as Exhibit A, the same being the model form election and notice as set out in 45 .F.R. Part 146 of the Federal Regulations should, in all things, be approved, and the Personnel irector, as plan manager, should be authorized to execute the same; NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PARIS, PARIS, EXAS: Section 1. That the findings set out in the preamble to this resolution are hereby in all things pproved. Section 2. That the form of Election and the form of Notice to Enrollees under 42 U.S.C. c. 300gg-21, which exempts the City of Paris from the requirements of the Health Insurance rtability and Accountability Act (HIPAA) and the Public Health Services Act (PHS), attached h reto as Exhibit A, be, and the same are hereby, approved. Section 3. That the Personnel Director, as plan manager, be, and he is hereby, authorized d directed to execute, on behalf of the City of Paris, the election form and distribute the a companying notice to enrollees pursuant to 42 U.S.C. Sec. 300gg-21, under the terms and c nditions and in the form shown in Exhibit A, attached hereto. Section 4. That this resolution shall be effective from and after its date of passage. PASSED AND APPROVED this 14th day of March, 2005. . , , ~.. .. "" r-fk (C-If'11W' @l~. J?;A\lRtII~1 ~-_ ;;J~~~ ~s. ~~_"-..\~~ p March 9, 2005 HCFA Atten: David Holstein 7500 Security Blvd. Room S-L17 Baltimore, MD 21244-1850 RE: Election to he exempted from certain requirements under HIP AA 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 May 1, 2005. 1. Limitations on pre-existing condition exclusion periods (146.11); 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 m~stectomy. 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) of45 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' group health plan is identified as follows: Name of Plan: Plan Sponsor: Plan Manager: City of Paris, Texas Intergovernmental Employee Benefits Pool City of Paris W.E. Anderson EXHIBIT A P.O. BOX 9037 . PARIS. TEXAS 75461-9037 . (903) 765.7511 . FAX (903) 765.6519 ...~ .. . ..... ..... .... ,'.'. As Plan Manager, I certify that I am authorized to submit this election on behalf of the Plan Sponsor, the City of Paris. A copy of the notice to our employees of our election to be exempted is enclosed. This notice will be included as part of our plan's summary plan description, to be distributed upon enrollment and each year to all covered employees. We appreciate written acknowledgment of this election. Sincerely, W. E. Anderson Personnel Director . . .,. - ." . .,... ,.^,~ NOTICE TO PLAN PARTICIPANTS REGARDING THE CITY OF PARIS' ELECTION UNDER 42 U.S.C. 300 GG-21 This is to notify you that Federal Law imDoses UDon erOUD health D1ans certain limitations of pre-existine condition exclusion Deriods. sDecial enrollment Deriods for individuals (and deDendents) losine other coveral!e. Drohibitions aeainst discriminatinl! aeainst individual particiDants and beneficiaries based on health status. standards relatinl! to benefits for mothers and newborns. Daritv in the aDDlication of certain limits to mental health benefits. and a woman's ril!ht to treatment ofthe unaffected breast followin~ a mastectomv. Federal law allows a non-federal governmental plan (such as the City of Paris' D1an) to exemDt its plan in whole or in Dart from these reauirements. The City of Paris has elected to be exemDt from the followinl! reauirements: limitations on Dre-existine condition exclusion Deriods: sDecia1 enrollment periods for individuals (and deDendents) 10sinl! coveraee: Drohibitions al!ainst discriminatinl! al!ainst individual DarticiDants and beneficiaries based on health status: standards reIatin!! to benefits for mothers and newborns: Daritv in the aDDlication of certain limits to mental health benefits: :and a woman's ril!ht to treatment of the affected breast and reconstructive sureerv followine a mastectomv. Because of this election. emDlovees and deDendents will be subiect to benefit limits even if thev had 12 or 18 months of coveral!e under another D1an within the last 63 days. the duration of a hosnita1 confinement for a mother and newborn followin!! the birth of a child will be determined on medical necessity. and mental health benefits have an annual maximum which is less than the maximums for other medical conditions. Even thoueh the Dlan is exemDt. emD10vees and deDendents will he able to enroll ifthev have a aualifvin!! event durine the D1an vearas set forth in this booklet and no individual will he declined coveraee '" or charl!ed a hil!her rate based on a medical condition. The D1an's Qualifvinl! events are more liberal than the federa11aw. The entire Dlan is subiect to this exemption. The exemDtion from these federal reQuirements wiII be in effect for the 2005 Dlan year bel!inninl! Mav 1. 2005 and endinl! ADri130. 2006. The election mav be renewed for subseQuent D1an vears. HIPAA also reQuires the D1an to Drovide covered emD10vees and dependents with a "certificate of creditable coveral!e" when they cease to be covered under the plan. There is no exemption from this reQuirement. The certificate provides evidence that yOU were covered under this D1an. because ifvou can establish vour Drior coveral!e. yOU mav be entitled to certain ril!hts to reduce or eliminate a Dre-existinl! condition exclusion if vou ioin another emp10ver's health plan. or ifvou wish to Durchase an individual health insurance policv. If vou have anv auestions. contact Stephanie Fouse at 903 784-9243. "