I M P O R TA N T I N F O R M AT I O N
KAI 2022 ENROLLMENT • PLANNING FOR YOUR BENEFITS
Important Information about Your Healthcare Rights General Information about Your Rights 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 of 2008 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.
22 | Lea r n m o re a b o u t y o u r b e n e fits by e ma ilin g b enef its @ Kao.c om o r by cal l i ng 800-650-8180
