Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)
An employee or dependent who is eligible, but not enrolled in this Plan, may enroll if:
- The employee or dependent is covered under a Medicaid plan under Title XIX of the Social Security Act or a state children’s health insurance program (CHIP) under Title XXI of such Act, and coverage of the employee or dependent is terminated due to loss of eligibility for such coverage, and the employee or dependent requests enrollment in this Plan within sixty (60) days after such Medicaid or CHIP coverage is terminated.
- The employee or dependent becomes eligible for assistance with payment of employee contributions to this Plan through a Medicaid or CHIP plan (including any waiver or demonstration project conducted with respect to such plan), and the employee or dependent requests enrollment in this Plan within sixty (60) days after the date the employee or dependent is determined to be eligible for such assistance.
If a dependent becomes eligible to enroll under this provision and the employee is not then enrolled, the employee must enroll in order for the dependent to enroll.
Coverage will become effective as of the date the request for enrollment is received by the employer
Newborns' and Mothers' Health Protection Act of 1996 (NMHPA)
Under federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not do any of the following:
- restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than forty-eight (48) hours following a vaginal delivery, or less than ninety-six (96) hours following a delivery by cesarean section
- set the level of benefits or out-of-pocket costs so that any later portion of the forty-eight (48) or ninety-six (96) hours, as applicable, stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay
- require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to forty-eight (48) or ninety-six (96) hours, as applicable
However, the plan or issuer may pay for a shorter stay than forty-eight (48) hours following a vaginal delivery, or ninety-six (96) hours following a delivery by cesarean section if the attending provider (e.g., your physician, nurse midwife or physician assistant), discharges the mother or newborn after consultation with the mother.
Genetic Information Nondiscrimination Act of 2008 (GINA)
GINA Title I applies to group health plans sponsored bty local government employers. Title I generally prohibits discrimination in group premiums based on genetic information and the use of genetic information as a basis for determining eligibility or setting premiums, and places limitations on genetic testing and the collection of genetic information in group health plan coverage. Title I provides a clarification with respect to the treatment of genetic information under privacy regulations promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Mental Health Parity and Addiction Act of 2008
Regardless of any limitations on benefits for mental disorders/substance abuse treatment otherwise specified in the Plan, any aggregate lifetime limit, annual limit, financial requirement, non-network exclusion, or treatment limitation on mental disorders/substance abuse benefits imposed by the Plan shall comply with federal parity requirements, if applicable.
Uniformed Services Employment and Re-employment Rights Act of 1994 (USERRA)
Employees going into or returning from military service may elect to continue Plan coverage as mandated by the Uniformed Services Employment and Re-employment Rights Act of 1994 (USERRA) under the following circumstances. These rights apply only to employees and their dependents covered under the Plan immediately before leaving for military service. For more information on USERRA, please refer to the USERRA Continuation of Coverage subsection.
Compliance with HIPAA Privacy Standards
Machine Readable Files
Please use this link to obtain the machine readable files. https://github.com/Ameriben/MRF
No Surprises Act
Your Rights and Protections
Against Surprise Medical Bills