Legal Notices

Michelle’s Law

A new law went into effect for health plans beginning January 1, 2010, called Michelle’s law. This law is a result of a medically necessary leave of absence from a post-secondary educational institution or change in enrollment that: (1) begins while the child is suffering from a serious illness or injury; (2) is certified by a physician as being medically necessary; and (3) causes the child to lose student status for purposes of coverage under the plan.

If the dependent child’s treating physician does not provide written documentation the child is suffering from a serious illness or injury and the leave of absence is medically necessary, the plan will not provide continued coverage.

Patient Protection Notice

The company Medical plan generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, visit UnitedHealthcare. For children, you may designate a pediatrician as the primary care provider.

You do not need prior authorization from the company Medical plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, visit UnitedHealthcare.

Women’s Health and Cancer Rights Act of 1998 Notice

As required by the Women’s Health and Cancer Rights Act of 1998, each Medical plan sponsored by the company provides coverage for the following breast reconstruction procedures in connection with mastectomies:

  • Reconstruction of the breast that was operated on.
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance.
  • Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.

Coverage is provided in a manner determined in consultation with the attending physician and the patient. The deductible, coinsurance and copayment requirements that apply to other covered services also apply to these post-mastectomy.

Special Enrollment Rights

If you decline enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in a company Medical plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). You must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

The plan will also allow a special enrollment opportunity if you or your eligible dependents either:

  • Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible, or
  • Become eligible for a state’s premium assistance program under Medicaid or CHIP.

For these enrollment opportunities, you will have 60 days — instead of 30 — from the date of the Medicaid/CHIP eligibility change to request enrollment in the plan. Note that this new 60-day extension doesn’t apply to enrollment opportunities other than the Medicaid/CHIP eligibility change.

Also, 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 in a company plan. You must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

To request special enrollment or to learn more, contact Human Resources.

Hospital Indemnity Insurance: Government-Required Notice

IMPORTANT: AI Fire offers hospital indemnity insurance as a fixed indemnity policy; this is NOT health insurance. If you are considering purchasing this policy, please read this notice in its entirety.

Disclaimer

Information on this website provides a summary of benefits. For a complete description of benefit provisions, please contact Human Resources.