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NOTICES

HIPAA Privacy 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 uses is voluntary except when required under Section 111 of Public Law 100-173.


COBRA Initial Notification

You are receiving this notice because you are currently covered under Maricopa County’s Health Insurance Program (the Plan). This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice generally 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 receive it.

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 when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional 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.

The Plan Administrator is Maricopa County Employee Benefits, located at 301 West Jefferson Street, Suite 3200, Phoenix, AZ 85003, and available via telephone by dialing 602-506-1010, press 2 and then 2 again to speak to a Representative or by emailing to BenefitsService@mail.maricopa.gov. The Plan Administrator is responsible for administering COBRA continuation coverage.

Under federal COBRA law, should you lose your group health insurance because of one of the below listed qualifying events, covered employees and covered family members (called qualified beneficiaries) will be offered the opportunity for a temporary extension of health coverage (called Continuation Coverage) at group rates which you will be required to pay. This notice is intended to inform all plan participants, in a summary fashion, of your potential future options and obligations under the continuation coverage provisions of federal law. Should an actual qualifying event occur in the future, the plan manager will send you additional information and the appropriate election notice at that time. Please take special note, however, of your notification obligations and procedures which are highlighted in this notification!

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as 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 are required to pay for COBRA continuation coverage, you will be notified at the time you are offered COBRA continuation coverage of the amount and the date payment is due.

If you are an employee, you will become a qualified beneficiary if you will lose your coverage under the Plan because either one of the following qualifying events happens:
1. Your hours of employment are reduced, or
2. Your employment ends for any reason other than your gross misconduct.

If you are the spouse of an employee, you will become a qualified beneficiary if you will lose your coverage under the Plan because any of the following qualifying events happens:
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 will lose coverage under the Plan because any of the following qualifying events happens:

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.”

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 with respect to the bankruptcy. 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 the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is 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), the employer must notify the Plan Administrator of the qualifying event (1) within 30 days of any of these events or (2) within 30 days following the date coverage ends.

You Must Give Notice of Some Qualifying Events

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), you must notify the Plan Administrator. Generally Plans require that notification of such events be provided to the Plan Administrator within 60 days after the qualifying event has occurred. 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 and as directed under the terms of the Plan located in the SPD.

How is COBRA Continuation Coverage Provided?

Once the Plan Administrator 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. When the qualifying event is death of the employee, the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two 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 at any time during the first 60 days of COBRA continuation coverage 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. You must make sure that you provide a copy of the SSA’s disability determination to the Plan Administrator prior to the last day of the initial 18-month COBRA continuation coverage period AND within 60 days of the latest of the dates listed below:

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, while receiving COBRA continuation coverage, your spouse and/or dependent child(ren) experiences another qualifying event which causes a loss of coverage, they can get additional months of COBRA continuation coverage, for a total of up to a maximum of 36 months from the date of the first qualifying event. This extension is available only 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), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. In all of these cases, you must make sure that the Plan Administrator is notified of the second qualifying event within 60 days of the second qualifying event. This notice must 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.*

*Please note: At the time you are being provided with this Initial General Notice of COBRA Rights, ADP Benefit Services is your employer’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 your employer and that ADP Benefits Services remains the appropriate place for you to send notice of a Social Security Disability or Second Qualifying event.

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 ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), 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 the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.)

Keep Your Plan Informed of Address Changes

In order to protect your family’s rights, you should keep the Plan Administrator informed of 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
Telephone number 602-506-1010
Fax number: 602-506-2354
Email: BenefitsService@mail.maricopa.gov

COBRA continuation coverage for the Plan is managed by:

ADP, Inc.
Telephone number 1-800-770-7981
https://www.benedirect.adp.com


The American Recovery and Reinvestment Act of 2009 (ARRA)

The American Recovery and Reinvestment Act of 2009 (ARRA) as amended by the Department of Defense Appropriations Act (2010 DOD Act) on December 19, 2009 and the Temporary Extension Act of 2010 (TEA) on March 2, 2010, provides for premium reductions for health benefits under COBRA. Eligible individuals pay 35 percent of their COBRA premiums; the remaining 65 percent is reimbursed to the coverage provider through a tax credit. The premium reduction applies to periods of health coverage that began on or after February 17, 2009 and lasts for up to 15 months.

To qualify, individuals must experience a COBRA qualifying event that is the involuntary termination of a covered employee’s employment. The involuntary termination must generally occur during the period that began September 1, 2008 and ends on March 31, 2010. However, TEA also provides that an involuntary termination of employment is a qualifying event for purposes of ARRA if the involuntary termination:

Income Limits

If an individual’s modified adjusted gross income for the tax year in which the premium assistance is received exceeds $145,000 (or $290,000 for joint filers), then the amount of the premium reduction during the tax year must be repaid. For taxpayers with adjusted gross income between $125,000 and $145,000 (or $250,000 and $290,000 for joint filers), the amount of the premium reduction that must be repaid is reduced proportionately. Individuals may permanently waive the right to premium reduction but may not later obtain the premium reduction if their adjusted gross incomes end up below the limits. If you think that your income may exceed the amounts above, consult your tax preparer or contact the IRS at www.irs.gov.


Women’s Health and Cancer Rights Act (WHCRA)

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 CIGNA Customer Service for more information.


Obtaining a Certificate of Creditable Coverage under This Plan

Upon loss of coverage under this Plan, a Certificate of Creditable Coverage will be mailed to each terminating individual at the last address on file. You or your dependent may also request a Certificate of Creditable Coverage, without charge, at any time while enrolled in the Plan and for 24 months following termination of coverage. You may need this document as evidence of your prior coverage to reduce any pre-existing condition limitation period under another plan, to help you get special enrollment in another plan, or to obtain certain types of individual health coverage even if you have health problems. To obtain a Certificate of Creditable Coverage, contact CIGNA Customer Service. ADP also provides Certificates of Creditable Coverage and may also be contacted to request a replacement copy.


General Notice of the Plan’s Pre-existing Condition Exclusion

The Open Access Plus and the Choice Fund Medical Plan impose a pre-existing condition exclusion. This means that if you have a medical condition before coming to a Maricopa County-sponsored plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within 60 calendar days prior to your effective date of coverage. The pre-existing condition exclusion does not apply to pregnancy or to a child under age 19 (effective July 1, 2011).

This exclusion may last up to 12 months from your first day of coverage. However, you can reduce the length of this exclusion period by the number of days of your prior “creditable coverage”.


Notice of Special Enrollment Rights

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:

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:


Genetic Information Nondiscrimination Act of 2008

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.


The Heroes Earnings Assistance and Relief Tax Act (HEART)

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 apremium 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
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)

U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Ext. 61565


Mental Health Parity and Addiction Equity Act of 2008

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 will be in effect starting with the 2010-11 plan year, beginning July 1, 2010 through June 30, 2011. The election may be renewed for subsequent plan years.

HIPAA also requires the Plan to provide covered employees and dependents with a “certificate of creditable coverage” 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 Plan, because if you can establish your prior coverage, you may be entitled to certain rights to reduce or eliminate a preexisting condition exclusion if you join another employer’s health plan, or if you wish to purchase an individual health insurance policy.


Medicare Part D Creditable Coverage Notice

Background

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.

Notice

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 coverageis 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:

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, 2014. If you drop your current Maricopa County prescription coverage, you must also drop your medical and behavioral health coverage. Retirees who drop current Maricopa County coverage will not be allowed to re-enroll in the Maricopa County Retiree Benefit Plan.

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:

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).