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Healthcare Rights
General Information about Your Rights
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Federal law provides you with certain rights regarding healthcare benefits. Please review this information to better understand what is available to you under the law.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, was signed into law on October 3, 2008. Under MHPAEA, group health plans with 51 or more employees, insurance companies and HMO’s offering mental health and substance abuse benefits are no longer allowed to set annual dollar limits, lifetime dollar limits, financial requirements (copays, deductibles, coinsurance, or out-of-pocket expenses) or day and visit maximums on mental health and substance abuse benefits that are more restrictive than those imposed on medical or surgical benefits. A plan that does not impose an annual or lifetime dollar limit on medical and surgical benefits may not impose such a dollar limit on mental health or substance abuse benefits offered under the plan.
Special Enrollment
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in the plan, provided that your request enrollment within 31 days after your other coverage ends (COBRA or state continuation coverage ends, divorce, legal separation, death, termination of employment or reduction in hours worked; or because the employer contributions cease).
In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 31 days after the marriage, birth, adoption or placement for adoption.
If you or your dependent lose coverage under a Medicaid Plan or Children’s Health Insurance Program (CHIP), or become eligible for group health plan premium assistance under a Medicaid Plan or under the CHIP, you may request enrollment within 60 days after coverage under the Medicaid or CHIP ends or within 60 after you or your dependent is determined to be eligible for state premium assistance under CHIP.
Women’s Health & Cancer Rights Act
On October 21, 1998 Congress passed a bill called the Women’s Health and Cancer Rights Act. This law requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. These services include: • Reconstruction of the breast upon which the mastectomy has been performed, • Surgery/reconstruction of the other breast to produce a symmetrical appearance, • Prostheses, and • Physical complications during all stages of mastectomy, including lymph edemas
In addition, the plan may not: • Interfere with a woman’s rights under the plan to avoid these requirements, or • Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the requirements of the law.
However, the plan may apply deductibles and copays consistent with other coverage provided by the plan.
Statement of Rights under the Newborns’ and Mothers’ Health Protection Act
Under federal law, group health plans offering group health coverage generally may not: • Restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (e.g., your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier. • 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. • Require that you, your physician, or other healthcare provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, you may be required to obtain pre-certification for any days of confinement that exceeds 48 hours (or 96 hours). For information on pre-certification, please refer to the Benefit Summaries.
HIPAA Notice of Privacy Practices
The Health Insurance Portability and Accountability Act (HIPAA) privacy rules require that health plans distribute a notice to participants of their privacy rights. This notice was provided to you upon enrollment in the plan. An updated notice was provided with the 2022 Open Enrollment materials. You may also request a hard copy of the notice by contacting the Benefits Team at 800-650-8180.
Nothing contained in the benefit plans described herein shall be held or construed to create a promise of employment or future benefits, or a binding contract between Kao America Inc., or its subsidiaries and affiliates, and its employees, retirees or their dependents, for benefits or for any other purpose.
As in the past, Kao America Inc. reserves the right, in its sole and absolute discretion, to amend, modify or terminate, in whole or in part, any or all of the provisions of the benefit plans described herein, including any health benefits that may be extended to retirees of Kao America Inc., or its subsidiaries or affiliates, and their dependents. Further, Kao America Inc. reserves the exclusive right, power and authority, in its sole and absolute discretion, to administer, apply and interpret the benefit plans described herein, and to decide all matters arising in connection with the operation or administration of such plans.
