HealthMatters October 2015, Issue 25download
- Important AlaskaCare Benefit Program Notices
- Cobra Coverage Reminder
- Important Notice from AlaskaCare About Your Prescription Drug Coverage and Medicare
- Women's Health and Cancer Rights Act of 1998 (WHCRA) Annual Notice Reminder
- Notice of Privacy Practices - AlaskaCare Health Plans
- Mid-Year Changes to Your AlaskaCare Employee Health Care Benefit Elections
- Newborns' and Mothers' Health Protection Act Notice
- Notice of Grandfathered Status
- Availability of Summary of Benefit and Coverage (SBC) Documents
- If You Have a Dependent Covered Under the AlaskaCare Employee Health Plan
- Premium Assistance Under Medicaid and The Children's Health Insurance Program (CHIP)
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.
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 at doa.alaska. gov/drb/alaskaCare/retiree/information/cobraPremiums.html and current active COBRA rates are available at doa.alaska.gov/drb/ alaskacare/employee/information/premiums.html.
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 at healthcare.gov. 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 document or pages 97-101 of the AlaskaCare Retiree Insurance Information Booklet.
Important Notice from AlaskaCare About Your Prescription Drug Coverage and Medicare
If you and/or your family members are not now eligible for Medicare and will not be eligible for Medicare during the next 12 months, you may disregard this notice. If, however, you and/or your family members are now eligible for Medicare or may become eligible for Medicare in the next 12 months, please read this notice very 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:
- 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.
- 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.
|Up to 30 Day Supply||31-90 Day Supply|
|All Drug||20% copay||20% copay|
|Minimum||$13 copay||$21 copay|
|Maximum||$61 copay||$122 copay|
|Brand Name||$20 copay|
|Annual Copay Maximum||$1,000 Invdividual $2,000 Family|
|Up to 90-Day or 100-Unit Supply|
|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.
For More Information About This Notice or Your AlaskaCare Prescription Drug Coverage…
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 at socialsecurity.gov, 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 2015
- 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) 465-4460
- Toll Free: (800) 821-2251
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 document or contact the concierge at (855) 784-8646.
Notice of Privacy Practices - AlaskaCare Health Plans
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. THIS NOTICE OF PRIVACY PRACTICE PERTAINS TO...
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
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/ocr/privacy/hipaa/complaints.
- We will not retaliate against you for filing a complaint.
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
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.
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
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: hhs.gov/ocr/privacy/hipaa/ understanding/consumers/index.html.
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
- 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
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.
- 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.
- Have coverage through Medicaid or a State Children's Health Insurance Program (CHIP) and you (or your dependents) lose eligibility for that coverage. However, you must request enrollment within 60 days after the Medicaid or CHIP coverage ends.
- Become eligible for a premium assistance program through Medicaid or CHIP. However, you must request enrollment within 60 days after you (or your dependents) are determined to be eligible for such assistance.
- Website: dol.gov/ebsa
- (866) 444-EBSA (3272)
- Website: cms.hhs.gov
- (877) 267-2323, Menu Option 4, Ext. 61565
For more information see: hhs.gov/ocr/privacy/hipaa/ understanding/consumers/noticepp.html.
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.
January 1, 2016
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, COBRA administration, 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, at (907) 465-2334 or email@example.com.
Mid-Year Changes to Your AlaskaCare Employee Health Care Benefit Elections
IMPORTANT: After this open enrollment period is completed, in accordance with IRS regulations, generally you will not be allowed to change your AlaskaCare Employee Health Plan benefit elections or add/delete dependents until next year's open enrollment unless you have a Special Enrollment Event, other Mid-year Change in Status or Other Applicable Event as outlined in the AlaskaCare Employee Health Plan. For more information, see Section 1.8.2 of the AlaskaCare Employee Health Plan document or contact the Division of Retirement and Benefits at 1-800-821-2251 or (907) 465-4460 in Juneau.
HIPAA Special Enrollment Events:
If you are an AlaskaCare eligible employee who is a full-time employee, you are required to participate in both the medical plan and the dental plan. The minimum level of coverage is in the economy medical and preventive dental but other options are available. There are situations in which you can change your elections mid-year, including the health flexible spending account (HFSA), consistent with your change in enrollment during the benefit year. If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll your dependents. However, you must request enrollment of the dependent within 30 days after the marriage, birth, adoption, or placement for adoption.
Your eligible dependents may also enroll in the plan if your dependents:
To request special enrollment or obtain more information on permissible mid-year changes, see Section 1.8.2 of the AlaskaCare Employee Health Plan document or contact the Division of Retirement and Benefits toll free at (800) 821-2251 or (907) 465- 4460 in Juneau.
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 outof- 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.
Notice of Grandfathered Status
This group health plan (sponsored by the State of Alaska) believes that the AlaskaCare Medical Plan options for employees are considered to be "grandfathered health plans" under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. As grandfathered health plans, the above noted plan options may not include certain consumer protections of the Affordable Care Act that apply to other plans such as the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act such as the elimination of lifetime limits on benefits.Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Division of Retirement and Benefits at (800) 821-2251 or (907) 465-4460 in Juneau. You may also contact the U.S. Department of Health and Human Services at hhs.gov.
Availability of Summary of Benefit and Coverage (SBC) DocumentsThe health benefits available to you from the State of Alaska AlaskaCare Employee Health Plan represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. In accordance with law, our employee plan provides you with Summary of Benefits and Coverage, or SBC, documents as a way to help you understand and compare medical plan benefits. Each SBC summarizes and compares important information including what is covered, what you need to pay for various benefits, what is not covered, and where to get answers to questions. SBC documents are updated when there is a change to the benefits information displayed on an SBC. To get a free copy of the most current SBC documents for our State of Alaska medical plan options, go to AlaskaCare.gov, or for a paper copy, contact the Division of Retirement and Benefits toll free at (800) 821-2251 or (907) 465-4460 in Juneau.
If You Have a Dependent 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 Dependent Enrolled 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 go to this website to complete a form to request a SSN: socialsecurity.gov/online/ss-5.pdf. 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 contact the Division of Retirement and Benefits at firstname.lastname@example.org, call toll free at (800) 821-2251 or (907) 465-4460 in Juneau.
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 are 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 are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit healthcare.gov.
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.gov 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 are not 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 Section 1.8.2(b) of the AlaskaCare Employee Health Plan document for additional information. If you have questions about enrolling in your employer plan, contact the Division of Retirement and Benefits at email@example.com, call toll free at (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 Section 1.8.2 of the AlaskaCare Employee Health Plan document for additional information. To see if any other states have added a premium assistance program since January 31, 2015, or for more information on special enrollment rights, contact either:
U.S. Department of Labor Employee Benefits Security Administration
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services
OMB Control Number 1210-0137 (expires 10/31/2016)