HealthMatters

October 2014, Number 23


Important AlaskaCare Benefit Program Notices

This newsletter contains important AlaskaCare benefit program notices of interest to you and your family. Please share this information with your family members. Some of the notices in this newsletter are required by law and other notices contain helpful information. These notices are updated from time to time and some of the federal notices are updated each year. Be sure you are reviewing the most updated version of these important notices.

Do you have questions about your health plan? Find answers in our Employee FAQ and Retiree FAQ.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, the State of Alaska may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in the State of Alaska, contact ALASKA – Medicaid at (888) 318-8890 or (907) 269-6529 in Anchorage to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact the Alaska Medicaid or CHIP office at (888) 318-8890 or (907) 269-6529 in Anchorage or visit InsureKidsNow to find out how to apply. If you qualify, ask Alaska Medicaid if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. Please see 1.8.2(b) of the AlaskaCare Employee Health Plan document for additional information. If you have questions about enrolling in your employer plan, email the Division of Retirement and Benefits or call (800) 821-2251 or (907) 465-4460 in Juneau.

You may also change your election if you have a change in status or other applicable event. Please see 1.8.2 of the AlaskaCare Employee Health Plan for additional information.

To see if any other states have added a premium assistance program since July 31, 2014, or for more information on special enrollment rights, contact either:

U.S. Department of Labor Employee Benefits Security Administration
Web site: www.dol.gov/ebsa
(866) 444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services
Web site: www.cms.gov
(877) 267-2323, Menu Option 4, Ext. 61565

OMB Control Number 1210-0137 (expires 10/31/2016)

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Women’s Health and Cancer Rights Act of 1998 (WHCRA) Annual Notice Reminder

If you are covered under the AlaskaCare Employee Health Plan, you or your dependents may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:

  • All stages of reconstruction of the breast on which the mastectomy was performed;
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance;
  • Prostheses; and
  • Treatment of physical complications of the mastectomy, including lymphedema.

Plan limits, deductibles, copayments, and coinsurance apply to these benefits. For more information on WHCRA benefits, see Section 13.10 of the AlaskaCare Employee Health Plan or contact the concierge at (855) 784-8646.

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Newborns’ and Mothers’ Health Protection Act Notice

Hospital Length of Stay for Childbirth: Under federal law, group health plans, like the AlaskaCare Employee Health Plan, generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or the newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, the Plan may pay for a shorter stay if the attending Physician (e.g., Physician, or Health Care Practitioner), after consultation with the mother, discharges the mother or newborn earlier.

Also, under federal law, plans may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay.

In addition, the AlaskaCare Employee Health Plan may not, under federal law, require that a Physician or other Health Care Practitioner obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain precertification. For information on precertification for a length of stay longer than 48 hours for vaginal birth or 96 hours for C-section, contact the concierge at (855) 784-8646 to precertify the extended stay. You may also contact the concierge if you have questions about this Notice. Please review section 13.2 of the AlaskaCare Employee Health Plan document for additional information.

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Cobra Coverage Reminder

In compliance with a federal law referred to as COBRA Continuation Coverage, this plan offers AlaskaCare members and their covered dependents (known as qualified beneficiaries) the opportunity to elect temporary continuation of their group health coverage when that coverage would otherwise end because of certain events (called qualifying events).

Qualified beneficiaries are entitled to elect COBRA when qualifying events occur, and, as a result of the qualifying event, coverage of that qualified beneficiary ends. Qualified beneficiaries who elect COBRA Continuation Coverage must pay for it at their own expense. Current retiree COBRA rates are available as are current active COBRA rates.

Qualifying events include termination of employment, reduction in hours of work making the employee ineligible for coverage, death of the employee, divorce/legal separation, or a child ceasing to be an eligible dependent child.

In addition to considering COBRA as a way to continue coverage, there may be other coverage options for you and your family. You may want to look for coverage through the Health Care Marketplace. In the Marketplace, you could be eligible for a tax credit that lowers your monthly premiums for Marketplace coverage, and you can see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll. Being eligible for COBRA does not limit your eligibility for coverage for a tax credit through the Marketplace. Additionally, you may qualify for a special enrollment opportunity for another group health plan for which you are eligible (such as a spouse’s plan) if you request enrollment within 30 days, even if the plan generally does not accept late enrollees.

The maximum period of COBRA coverage is generally either 18 months or 36 months, depending on which qualifying event occurred.

In order to have the chance to elect COBRA coverage after a divorce/legal separation or a child ceasing to be a dependent child under the plan, you and/or a family member must inform the plan in writing of that event no later than 60 days after that event occurs. That notice should be sent to:

  • Division of Retirement and Benefits
  • P.O. Box 110203
  • Juneau, AK 99811-0203

The notice should be sent via first class mail and is to include the AlaskaCare member’s name, the qualifying event, the date of the event, and the appropriate documentation in support of the qualifying event (such as divorce documents).

If you have questions about COBRA, contact the concierge at (855) 784-8646. For a complete list of qualifying events and for additional information on your COBRA rights refer to section 8 of the AlaskaCare Employee Health Plan or pages 97-101 of the AlaskaCare Retiree Insurance Information Booklet.

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AlaskaCare Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You have the right to:

  • Get a copy of your health and claims records
    • You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
    • We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
  • Ask us to correct health and claims records
    • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
    • We may say “no” to your request, but we’ll tell you why in writing within 60 days.
  • Request confidential communications
    • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
    • We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
  • Ask us to limit what we use or share
    • You can ask us not to use or share certain health information for treatment, payment, or our operations.
    • We are not required to agree to your request, and we may say “no” if it would affect your care.
  • Get a list of those with whom we’ve shared information
    • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
    • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
  • Get a copy of this privacy notice
    • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
  • Choose someone to act for you
    • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
    • We will make sure the person has this authority and can act for you before we take any action.
  • File a complaint if you feel your rights are violated
    • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting HHS.gov.
    • We will not retaliate against you for filing a complaint.

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Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

  • In these cases, you have both the right and choice to tell us to:
    • Share information with your family, close friends, or others involved in payment for your care.
    • Share information in a disaster relief situation. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
  • In these cases we never share your information unless you give us written permission:
    • Marketing purposes.
    • Sale of your information.

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Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways:

  • Help manage the health care treatment you receive
    • We can use your health information and share it with professionals who are treating you.
    • Share information in a disaster relief situation. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
  • Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.

  • Run our organization
    • We can use and disclose your information to run our organization and contact you when necessary.
    • We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.
  • Example: We use health information about you to develop better services for you.

  • Pay for your health services
    • We can use and disclose your health information as we pay for your health services.
  • Example: We share information about you with your dental plan to coordinate payment for your dental work.

  • Administer your plan
    • We may disclose your health information to your health plan sponsor for plan administration.
  • Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.

  • How else can we use or share your health information?
    • We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see HSS.gov.
  • Help with public health and safety issues

    We can share health information about you for certain situations such as:

    • Preventing disease
    • Helping with product recalls
    • Reporting adverse reactions to medications
    • Reporting suspected abuse, neglect, or domestic violence
    • Preventing or reducing a serious threat to anyone’s health or safety
  • Do research
    • We can use or share your information for health research
  • Comply with the law

    We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

  • Respond to organ and tissue donation requests and work with a medical examiner or funeral director
    • We can share health information about you with organ procurement organizations.
    • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
  • Address workers’ compensation, law enforcement, and other government requests

    We can use or share health information about you:

    • For workers’ compensation claims
    • For law enforcement purposes or with a law enforcement official
    • With health oversight agencies for activities authorized by law
    • For special government functions such as military, national security, and presidential protective services
  • Respond to lawsuits and legal actions
    • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

    We will not market or sell your personal information.

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Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see HHS.gov.

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Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.

This Notice of Privacy Practices applies to the following organizations:

This Notice of Privacy Practices applies to the benefits in the State of Alaska Employee Health Plan and State of Alaska Retiree Benefit Plan that pay for the cost of, or provide medical benefits (which may include health, dental, vision, employee assistance, wellness, medical flexible spending accounts, or other coverage affecting any structure of the body as those benefits may be offered from time to time). It does not apply to other benefits provided by the State of Alaska, such as life insurance, disability benefits, or accidental death and dismemberment insurance. If you receive health benefits through an insurance company through the State of Alaska you may also receive a notice from the insurer. That notice will describe how the insurer will use your health information and provide your rights.

For questions, contact Jennifer Dalton, HIPAA Privacy Officer:
(907) 465-2334
Email Jennifer

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Prescription Drug Coverage and Medicare Notice

Please read this notice carefully and keep it where you can find it.

This notice has information about your AlaskaCare prescription drug coverage and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current AlaskaCare coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

  1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
  2. The State of Alaska has determined that the prescription drug coverage offered by the AlaskaCare Health Plans is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join a Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan?

If you decide to join a Medicare drug plan, your AlaskaCare coverage will be affected as follows. If you are a participant in the retiree health plan and purchase Medicare prescription drug coverage, your AlaskaCare plan will become supplemental to Medicare’s drug plan. Conversely, if you are a participant in the employee health plan and purchase Medicare prescription drug coverage, Medicare will become the secondary prescription drug plan.

If you are a participant in the retiree health plan and decide to join a Medicare drug plan and drop your current AlaskaCare coverage, be aware that you and your dependents will not be able to get this coverage back.

Benefits Provided by your AlaskaCare Prescription Drug Plan (employee plan):
Up to 30 Day Supply 31-90 Day Supply
Participating Pharmacy
All Drug 20% copay 20% copay
Minimum $13 copay $21 copay
Maximum $61 copay $122 copay
Mail Order
Generic   $8 copay
Brand Name   $20 copay
Annual Copay Maximum $ 1,000 Individual; $ 2,000 Family
Benefits Provided by your AlaskaCare Prescription Drug Plan (retiree plan):
Up to 90-Day or 100-Unit Supply
Brand Name $8
Generic
$4
Brand Name Mail Order $0
Generic Mail Order $0

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?

You should also know that if you drop or lose your AlaskaCare coverage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?

Contact the Alaska Medicare Information Office at (800) 478-6065 (in Anchorage (907) 269-3680) or the Aetna concierge at (855) 784-8646.

NOTE: You’ll receive this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if there are any changes to your AlaskaCare prescription drug coverage. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:

  • Visit Medicare.gov
  • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
  • Call (800) MEDICARE (1-800 -633-4227), TTY users should call (877) 486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the Web or call them at (800) 772-1213, TTY users should call (800) 325-0778.

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Date: October 2014

Name of Sender: State of Alaska, Division of Retirement and Benefits

Contact: Member Services Contact Center

Address: PO Box 110203, Juneau, AK 99811-0203

Telephone: (907) 465-4467 Toll Free: (800) 821-2251

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If You Are an Employee Covered Under the AlaskaCare Employee Health Plan…

...Don’t Forget to Provide the Plan with the Taxpayer Identification Number or Social Security Number of Each Enrollee in a Health Plan

Employers are required by law to collect the taxpayer identification number (TIN) or Social Security number (SSN) of each medical plan participant and provide that number on reports that will be provided to the IRS each year. Employers are required to make at least two consecutive attempts to gather missing TINs/SSNs.

If a dependent does not yet have a Social Security number, you can request one by completing a form available on the Social Security Administration's Web site. Applying for a Social Security number is FREE.

If you have not yet provided the Social Security number (or other TIN) for each of your dependents that you have enrolled in the health plan, please email the Division of Retirement and Benefits or call toll free at (800) 821-2251 or (907) 465-4460 in Juneau.

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Initiate Countdown to Open Enrollment

Make your benefit elections for 2015 from November 5–26, 2014.

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