HIPAA Privacy Notice
COBRA Initial Notification
Women's Health and Cancer Rights Act (WHCRA)
Notice of Special Enrollment Rights
Medicare Secondary Payor
Genetic Information Nondescrimination Act (GINA)
The Heros Earnings Assistance and Relief Tax Act (HEART)
Notice of Medicaid or Children’s Health Insurance Program (CHIP)
Mental Health Parity and Addiction Equity Act
Medicare Part D Creditable Coverage Notice
In accordance with the privacy standards contained in the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Maricopa County, in its role as the administrator and/or sponsor of the Maricopa County Health Insurance Program, or in its role as the health plan makes available a notice setting forth its privacy practices through the EBC/Intranet home page. This notice describes the potential uses and disclosures of Protected Health Information (PHI), the individual’s rights and the plan’s legal duties with respect to PHI. The privacy notice may be updated occasionally and such updates will be communicated through notices posted on the EBC.
Click here to view Maricopa County's Group Health Plan Notice of Privacy Practices
Social Security Number or Health Insurance Claim Number use:
Disclosure of your Social Security Number (SSN) or your health insurance claim number (if enrolled in Medicare) for purposes of enrollment and other benefit-related use is required under Section 111 of Public Law 100-173 and the Affordable Care Act.
Maricopa County Group Health Insurance Program (the Plan) is sponsored by Maricopa County. If you have any questions regarding eligibility requirements, please consult the Plan’s Summary Plan Description (SPD).
The Plan Administrator is Maricopa County Employee Benefits Division, located at 301 West Jefferson Street, Suite 3200, Phoenix, AZ 85003, and available via telephone by dialing 602-506-1010 to speak to a Representative or by emailing BenefitsService@mail.maricopa.gov. The Plan Administrator is responsible for administering COBRA continuation coverage.
This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that my cost less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA). COBRA continuation coverage can become available to you and other members of your family when you would otherwise lose your group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan) even if that plan generally doesn’t accept late enrollees.
What is COBRA Continuation Coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage may be required to pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you will lose your coverage under the Plan because of the following qualifying events:
1. Your hours of employment are reduced, or
2. Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:
1. Your spouse dies;
2. Your spouse’s hours of employment are reduced;
3. Your spouse’s employment ends for any reason other than his or her gross misconduct;
4. Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
5. You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:
1. The parent-employee dies;
2. The parent-employee’s hours of employment are reduced;
3. The parent-employee’s employment ends for any reason other than his or her gross misconduct;
4. The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
5. The parents become divorced or legally separated; or
6. The child stops being eligible for coverage under the plan as a “dependent child.”
Additional information related to retiree health coverage (if applicable)
If the Plan provides retiree health coverage, please review the following:
Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to Maricopa County, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee is a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent children will also be qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.
When is COBRA Continuation Coverage Available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after ADP Benefit Services has been notified that a qualifying event has occurred. Maricopa County must notify ADP Benefit Services of the following qualifying events:
- The end of employment or reduction of hours of employment;
- Death of the employee;
- Commencement of a proceeding in bankruptcy with respect to the employer, or
- The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), generally you must notify the Plan Administrator within 60 days after the qualifying event occurs. However, your Plan may allow a longer period of time to provide notification. Please consult your Plan’s SPD to determine the Plan’s qualifying event notification requirements. You must send this notice to: Maricopa County Employee Benefits Division and as directed under the terms of the Plan located in the SPD.
How is COBRA Continuation Coverage Provided?
Once ADP Benefits Services receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability extension of 18-month period of continuation coverage
If you or anyone in your family covered under the Plan is determined by the Social Security Administration (SSA) to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to start at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.
This notice should be sent to: Maricopa County Employee Benefits or other party as indicated in the COBRA Election Notice you receive at the time you are offered COBRA continuation coverage.*
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and dependent children if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.*
*Please note: At the time you are being provided with this Initial General Notice of COBRA Rights, ADP Benefit Services is Maricopa County’s COBRA administrator. In the future, you should refer to the COBRA Election Notice you receive at the time you are offered COBRA continuation coverage to confirm that ADP Benefits Services still performs this function for Maricopa County and that ADP Benefits Services remains the appropriate place for you to send notice of a Social Security Disability or Second Qualifying event.
Are there other coverage options besides COBRA continuation coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.HealthCare.gov
If You Have Questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act (PPACA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.) For more information about the Marketplace, visit www.HealthCare.gov.
Keep Your Plan Informed of Address Changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Plan Contact Information
Maricopa County Employee Benefits Division
301 West Jefferson Street, Suite 3200
Phoenix, Arizona 85003-2145
Telephone number 602-506-1010
Fax number: 602-506-2354
COBRA continuation coverage for the Plan is managed by:
Telephone number 1-855-219-5022
Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including Lymphedema. Call your Medical Plan Customer Service for more information.
In general, IRS restrictions prevent you from making changes to your coverage elections during the plan year. This means that once you make your health plan elections at Open Enrollment, you may not drop dependents or change your coverage until the next Open Enrollment period. You may be able to add or drop dependents during the plan year (but not change your plan coverage) if you experience and report a life event, also known as a qualified status change. These changes include the following:
- You get married or divorced.
- You acquire a dependent child through birth, adoption or placement for adoption.
- Your spouse or dependent dies.
- Your dependent no longer meets the plan’s eligibility requirements.
- Your spouse terminates employment or begins new employment.
- You or your spouse change from part-time work to full-time work (or vice-versa).
- You or your spouse has a significant change in the cost of health care coverage.
- You are required to provide dependent medical coverage as a result of a valid court decree that meets the requirements of a Qualified Medical Child Support Order (QMCSO).
- You or your dependent’s Medicaid or SCHIP coverage is terminated as a result of loss of eligibility. (An employee must be given at least 60 days after the date of termination of the coverage to request special enrollment.)
- You or your dependents become eligible for a state premium assistance subsidy under the plan from Medicaid or SCHIP. (An employee must be given a period of at least 60 days after the date on which eligibility for premium assistance has been determined to request special enrollment.)
Any benefit enrollment change you make must be consistent with your qualified status change. To change your coverage, enter the status change online through the Benefit Enrollment System via the ADP portal within 30 calendar days (or 60 days as noted above) of the date you experience the status change. A request for the required documentation of your status change will be mailed to your home address. Your new elections will be effective on either the date of your status change or the date your status change was processed, and retroactive payroll deductions may be withheld. If you do not complete your status change online within the 30 calendar day (or 60 days as noted above) period, you must wait until the next Open Enrollment period to change your benefits.
Medicare Secondary Payer Mandatory Insurer Reporting Requirements of Sect. 111of the Medicare, Medicaid, and SCHIP Extension Act of 2007(P.L. 110-173 42 U.S.C. § 1395y(b)(7))
Requires the collection and reporting of the Social Security Number (or Medicare Health Insurance Claim Number “HICN”) from active covered individuals. Active covered individuals are:
- employees and covered family members age 45 and older,
- employees and covered dependents who receive kidney dialysis or have had a kidney transplant, and
- any covered individual that the plan sponsor knows to be entitled to Medicare.
Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA) protects applicants and employees from discrimination based on genetic information in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. GINA also restricts employers’ acquisition of genetic information and strictly limits disclosure of genetic information. Genetic information includes information about genetic tests of applicants, employees, or their family members; the manifestation of diseases or disorders in family members (family medical history); and requests for or receipt of genetic services by applicants, employees or their family members.
HEART amended the Internal Revenue Code Section 125 to allow employers to provide qualified reservist distributions (QRDs) from health flexible spending accounts (FSAs) to employee-reservists who are called to active duty for 180 or more days, or for an indefinite period of time. A QRD is a distribution of all or a portion of the balance in an employee’s account that is requested during the period that begins on the date of the call up and ends on the last date that the reimbursement could otherwise be made under the health FSA for the plan year. These distributions may be made after June 17, 2008.
Notice of Medicaid or Children's Health Insurance Program (CHIP) Offer of Free or Low-Cost Health Coverage to Children and Families
If you are eligible for employment-based health coverage from Maricopa County, but are unable to afford the premiums, the State of Arizona may provide a premium assistance program that can help pay for coverage. The State may use funds from its Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Arizona’s Medicaid (AHCCCS) or CHIP (KidsCare) programs, you can contact the State’s Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid (AHCCCS) or CHIP (KidsCare), and you think you or any of your dependents might be eligible for either of these programs, you may contact the Arizona Medicaid or CHIP office at http://www.azahcccs.gov/applicants/default.aspx. You may also dial 1-877-KIDS-NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask if Arizona has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
For more information on special enrollment rights, you can contact the following federal agencies:
U.S. Department of Labor
U.S. Department of Health and Human Services
Under a Federal law known as the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended (“HIPAA”), group health plans must generally comply with the requirement listed below. However, the law also permits local governmental employers that sponsor health plans to elect to exempt a plan from these requirements for any part of the plan that is “self-funded” by the employer, rather than provided through a health insurance policy. Maricopa County has elected to exempt the Maricopa County Accident and Health Insurance Premium Plan (Second Amendment and Restatement) from the following requirement:
Parity in the application of certain limits to mental health benefits. Group health plans (of employers that employ more than 50 employees) that provide both medical and surgical benefits and mental health or substance use disorder benefits must ensure that financial requirements and treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant financial requirements and treatment limitations applicable to substantially all medical and surgical benefits covered by the plan.
The exemption from these Federal requirements has been in effect since the Maricopa County Plan Year 2010-11, beginning July 1, 2010 through June 30, 2011 and has been renewed for PY 2011-12, PY 2012-13, PY 2013-14, PY 2014-15 and PY 2015-16. The election may be renewed for subsequent plan years.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires group health plans that provide prescription drug coverage to disclose to individuals eligible for Medicare Part D whether the plan’s coverage is “creditable,” i.e., whether it is at least actuarially equivalent to the Medicare Part D coverage. Importantly, individuals who do not enroll in Medicare Part D when first eligible and who have gone 63 days or longer without creditable coverage generally will have to pay higher premiums permanently if they subsequently enroll. Thus individuals need to know the status of their coverage in order to make an informed decision about enrolling in Part D.
This notice applies to you if you are eligible for Medicare. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Maricopa County 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 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.
- Maricopa County has determined that the prescription drug coverage offered by the Employee Benefit Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore 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 November 15th through December 31st.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will 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 current Maricopa County coverage will not be affected. Your current coverage will be primary over the Medicare drug plan.
If you do decide to join a Medicare drug plan, you will not be able to drop your current Maricopa County prescription coverage until the next Open Enrollment period that would be effective July 1, 2015. If you drop your current Maricopa County prescription coverage, you must also drop your medical and behavioral health coverage.
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 current coverage with Maricopa County 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 nineteen 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 November to join.
For More Information About This Notice Or Your Current Prescription Drug Coverage, Refer to the Contact Information Located At The End Of This Notice
NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Maricopa County changes. 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 www.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 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
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 www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
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).
Name of Entity/Sender:
Maricopa County Department of Employee Benefits and Health
301 West Jefferson Street, Suite 3200, Phoenix, AZ 85003