Return to flip book view
1REQUIRED NOTICES
Item EHB Benefit EHB CategoryBenchmark Page # Reference1 Accidental Injury -- Dental Ambulatory Pgs. 10 & 17 Yes2 Allergy Injections and Testing Ambulatory Pg. 11 Yes3 Bone anchored hearing aids Ambulatory Pgs. 17 & 35 Yes4 Durable Medical Equipment Ambulatory Pg. 13 Yes5 Hospice AmbulatoryPg. 28 Yes6 Infertility (Fertility) Treatment Ambulatory Pgs. 23 - 24 Yes7 Outpatient Facility Fee (e.g., Ambulatory Surgery Center) AmbulatoryPg. 21Yes8Outpatient Surgery Physician/Surgical Services (Ambulatory Patient Services)Ambulatory Pgs. 15 - 16 Yes9 Private-Duty Nursing Ambulatory Pgs. 17 & 34 Yes10 Prosthetics/Orthotics Ambulatory Pg. 13 Yes11 Sterilization (vasectomy men) Ambulatory Pg. 10 Yes12 Temporomandibular Joint Disorder (TMJ) Ambulatory Pgs. 13 & 24 Yes13Emergency Room Services(Includes MH/SUD Emergency)Emergency services Pg. 7 Yes14 Emergency Transportation/ Ambulance Emergency services Pgs. 4 & 17 Yes15 Bariatric Surgery (Obesity) Hospitalization Pg. 21 Yes16 Breast Reconstruction After Mastectomy Hospitalization Pgs. 24 - 25 Yes17 Reconstructive Surgery Hospitalization Pgs. 25 - 26, & 35 Yes18 Inpatient Hospital Services (e.g., Hospital Stay) Hospitalization Pg. 15 Yes19 Skilled Nursing Facility Hospitalization Pg. 21 Yes20Transplants - Human Organ Transplants (Including transportation & lodging)Hospitalization Pgs. 18 & 31 Yes21 Diagnostic Services Laboratory servicesPgs. 6 & 12Yes22 Intranasal opioid reversal agent associated with opioid prescriptions MH/SUD Pg. 32 Yes23Mental (Behavioral) Health Treatment (Including Inpatient Treatment)MH/SUD Pgs. 8 -9, 21 Yes24 Opioid Medically Assisted Treatment (MAT) MH/SUD Pg. 21 Yes25 Substance Use Disorders (Including Inpatient Treatment) MH/SUD Pgs. 9 & 21 Yes26 Tele-Psychiatry MH/SUD Pg. 11 Yes27 Topical Anti-Inflammatory acute and chronic pain medication MH/SUDPg. 32Yes28 Pediatric Dental Care Pediatric Oral and Vision Care See AllKids Pediatric Dental Document No29 Pediatric Vision Coverage Pediatric Oral and Vision CarePgs. 26 - 27No30 Maternity Service Pregnancy, Maternity, and Newborn Care Pgs. 8 & 22 Yes31 Outpatient Prescription Drugs Prescription drugsPgs. 29 - 34YesName of Issuer:Plan Marketing Name:Employer Name:Employer State of Situs:2020-2024 Illinois Essential Health Benefit (EHB) Listing (P.A. 102-0630)Morreale Real Estate ServicesTen (10) Essential Health Benefit (EHB) Categories:- Ambulatory patient services (outpatient care you get without being admitted to a hospital)- Emergency services- Hospitalization (like surgery and overnight stays)- Laboratory services- Mental health and substance use disorder (MH/SUD) services, including behavioral health treatment (this includes counseling and psychotherapy)- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)- Pregnancy, maternity, and newborn care (both before and after birth)- Prescription drugs- Preventive and wellness services and chronic disease management- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)Illinois2024Blue Cross Blue Shield of IllinoisMIEEE4044, MIESA2122, MICOE4064Employer Plan Covered Benefit?Plan Year:Page 1 of 2
32 Colorectal Cancer Examination and Screening Preventive and Wellness Services Pgs. 12 & 16 Yes33 Contraceptive/Birth Control Services Preventive and Wellness Services Pgs. 13 & 16 Yes34 Diabetes Self-Management Training and Education Preventive and Wellness ServicesPgs. 11 & 35Yes35 Diabetic Supplies for Treatment of Diabetes Preventive and Wellness Services Pgs. 31 - 32 Yes36 Mammography - Screening Preventive and Wellness Services Pgs. 12, 15, & 24 Yes37 Osteoporosis - Bone Mass Measurement Preventive and Wellness Services Pgs. 12 & 16 Yes38Pap Tests/ Prostate- Specific Antigen Tests/ Ovarian Cancer Surveillance TestPreventive and Wellness Services Pg. 16 Yes39 Preventive Care Services Preventive and Wellness Services Pg. 18 Yes40 Sterilization (women) Preventive and Wellness Services Pgs. 10 & 19 Yes41 Chiropractic & Osteopathic Manipulation Rehabilitative and Habilitative Services and Devices Pgs. 12 - 13 Yes42 Habilitative and Rehabilitative Services Rehabilitative and Habilitative Services and Devices Pgs. 8, 9, 11, 12, 22, & 35 YesSpecial Note: Under Pub. Act 102-0104, eff. July 22, 2021, any EHBs listed above that are clinically appropriate and medically necessary to deliver via telehealth services must be covered in the same manner as when those EHBs are delivered in person.Page 2 of 2
2Required NoticesNewborn and Mothers’ Health Protection ActGroup health plans and health insurance issuers generally may not, under federal law, 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 cesarean section. However, federal law generally does not prohibit the mother’s or newborn's attending provider, after consulting with the mother, from discharging the mother or newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Women’s Health and Cancer Rights ActIn October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a covered mastectomy is also entitled to the following benefits: 1. All stages of reconstruction of the breast on which the mastectomy has been preformed: 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. Prostheses and treatment of physical complications of the mastectomy, including lymphedemas. Health plans must provide coverage of mastectomy related benefits in a manner determined in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and insurance amounts that are consistent with those that apply to other benefits under the plan.
Required CHIP Notice Premium Assistance Under Medicaid and theChildren’s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2024. Contact your State for more information on eligibility –ALABAMA – Medicaid COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)Website: http://myalhipp.com/Phone: 1-855-692-5447Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/HIBI Customer Service: 1-855-692-6442ALASKA – Medicaid FLORIDA – MedicaidThe AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/ Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspxWebsite: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.htmlPhone: 1-877-357-3268ARKANSAS – Medicaid GEORGIA – Medicaid Website: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)GA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162, Press 1GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization-act-2009-chipraPhone: (678) 564-1162, Press 2CALIFORNIA – Medicaid INDIANA – Medicaid Website: Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hippPhone: 916-445-8322Fax: 916-440-5676Email: hipp@dhcs.ca.govHealthy Indiana Plan for low-income adults 19-64Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other Medicaid Website: https://www.in.gov/medicaid/Phone 1-800-457-4584IOWA – Medicaid and CHIP (Hawki) NEBRASKA – Medicaid Medicaid Website: https://dhs.iowa.gov/ime/membersMedicaid Phone: 1-800-338-8366Hawki Website: http://dhs.iowa.gov/HawkiHawki Phone: 1-800-257-8563HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hippHIPP Phone: 1-888-346-9562Website: http://www.ACCESSNebraska.ne.govPhone: 1-855-632-7633Lincoln: 402-473-7000Omaha: 402-595-1178 KANSAS – Medicaid NEVADA – MedicaidWebsite: https://www.kancare.ks.gov/Phone: 1-800-792-4884Medicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900KENTUCKY – Medicaid NEW HAMPSHIRE – MedicaidKentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website:https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspxPhone: 1-855-459-6328Email: KIHIPP.PROGRAM@ky.govKCHIP Website: https://kynect.ky.gov Phone: 1-877-524-4718Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dmsWebsite: https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-programPhone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext 5218LOUISIANA – Medicaid NEW JERSEY – Medicaid and CHIPWebsite: www.medicaid.la.gov or www.ldh.la.gov/lahippPhone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710
Required CHIP Notice (CONT)MAINE – Medicaid NEW YORK – MedicaidEnrollment Website: https://www.mymaineconnection.gov/benefits/s/?language=en_USPhone: 1-800-442-6003TTY: Maine relay 711Private Health Insurance Premium Webpage:https://www.maine.gov/dhhs/ofi/applications-formsPhone: 1-800-977-6740 TTY: Maine relay 711Website: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831MASSACHUSETTS – Medicaid and CHIP NORTH CAROLINA – MedicaidWebsite: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840TTY: 711Website: https://medicaid.ncdhhs.gov/Phone: 919-855-4100MINNESOTA – Medicaid NORTH DAKOTA – MedicaidWebsite: https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/other-insurance.jspPhone: 1-800-657-3739Website: https://www.hhs.nd.gov/healthcarePhone: 1-844-854-4825MISSOURI – Medicaid OKLAHOMA – Medicaid and CHIPWebsite: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005Website: http://www.insureoklahoma.orgPhone: 1-888-365-3742MONTANA – Medicaid OREGON – MedicaidWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084Email: HHSHIPPProgram@mt.govWebsite: http://healthcare.oregon.gov/Pages/index.aspxPhone: 1-800-699-9075PENNSYLVANIA – Medicaid and CHIP VERMONT– MedicaidWebsite: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP-Program.aspxPhone: 1-800-692-7462CHIP Website: https://dhs.pa.gov/CHIP/Pages/CHIP.aspx CHIP Phone: 1-800-986-KIDS (5437)Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health AccessPhone: 1-800-250-8427RHODE ISLAND – Medicaid and CHIP VIRGINIA – Medicaid and CHIPWebsite: http://www.eohhs.ri.gov/Phone: 1-855-697-4347, or 401-462-0311 (Direct Rite Share Line)Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/famis-selecthttps://coverva.dmas.virginia.gov/learn/premium-assistance/health-insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924SOUTH CAROLINA – Medicaid WASHINGTON – MedicaidWebsite: https://www.scdhhs.govPhone: 1-888-549-0820Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022SOUTH DAKOTA - Medicaid WEST VIRGINIA-Medicaid and CHIPWebsite: http://dss.sd.govPhone: 1-888-828-0059Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/Medicaid Phone: 304-558-1700CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)TEXAS – Medicaid WISCONSIN – Medicaid and CHIPWebsite: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human ServicesPhone: 1-800-440-0493Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htmPhone: 1-800-362-3002UTAH – Medicaid and CHIP WYOMING – MedicaidMedicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/Phone: 1-800-251-1269To see if any other states have added a premium assistance program since July 31, 2024, or for more information on special enrollment rights, contact either:U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Serviceswww.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.OMB Control Number 1210-0137 (expires 1/31/2026)
HIPAA NoticeHIPAA Privacy NoticesHIPAA requires group health plans to provide a notice of current privacy practices regarding protected personal health information (PHI) to enrolled participants. All employers must distribute HIPAA Privacy Notices if the plan is self-funded or if the plan is fully- insured and the employer has access to PHI. If the employer maintains a benefits website, the HIPAA Privacy Notice must be included on the website.The HIPAA Privacy Notice must be written in plain language and must describe three things: (1) the use and disclosures of PHI that may be made by the group health plan; (2) plan participants’ privacy rights; and (3) the group health plan’s legal responsibilities with respect to the PHI.The Department of Health and Human Services (HHS) has developed three different model Privacy Notices for health plans to choose from: booklet version, layered version, and full-page version.More information can be found at: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/privacy-practices-for-protected-health-information/index.html Link to model notice: http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/nppbooklet_health_plan.pdf Link to OneDigital’s privacy policy: https://www.onedigital.com/privacy-policy/ Model Special Enrollment Notice The following is language that group health plans may use as a guide when crafting the special enrollment notice: If you are declining 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 this 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). However, you must request enrollment within the appropriate time period that applies under the plan after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). 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. However, you must request enrollment within the appropriate time period that applies under the plan after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact the appropriate plan representative.More information can be found at: https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/hipaa-compliance Link to model notice: https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/publications/compliance-assistance-guide-appendix-c.pdf For additional information on your employer’s privacy policy, please contact your HR department.
Required Notice: Exchange/ Marketplace Availability Notice New Health Insurance Marketplace Coverage Options and Your Health CoveragePart A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application Form ApprovedOMB No. 1210-0149 (expires 6-30-2023)
Exchange/ Marketplace Availability Notice Cont.Form ApprovedOMB No. 1210-0149 (expires 6-30-2023) Morreale Real Estate455 Taft AveGlen EllynIL60137Aaron Raffel630-545-5316xFull time eligible employeesSpouses, Dependent children until the age of 26 and disabled dependentsxxaaronr@morrealeres.com36-4333885
Notice of COBRA Continuation Coverage RightsIntroductionYou’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more 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. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage?COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called 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 must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:▪ Your hours of employment are reduced, or▪ Your employment ends for any reason other than your gross misconduct.If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:▪ Your spouse dies;▪ Your spouse’s hours of employment are reduced;▪ Your spouse’s employment ends for any reason other than his or her gross misconduct; ▪ Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or▪ You become divorced or legally separated from your spouse.Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:▪ The parent-employee dies;▪ The parent-employee’s hours of employment are reduced;▪ The parent-employee’s employment ends for any reason other than his or her gross misconduct;▪ The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);▪ The parents become divorced or legally separated; or▪ The child stops being eligible for coverage under the Plan as a “dependent child.”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. The employer must notify the Plan Administrator of the following qualifying events:▪ The end of employment or reduction of hours of employment; ▪ Death of the employee; ▪ The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both);Required Notice: COBRA
For all 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 within 60 days after the qualifying event occurs. You must provide this notice to: Human Resources.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 that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.Are there other coverage options besides COBRA Continuation Coverage?Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends? In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of :▪ The month after your employment ends; or ▪ The month after group health plan coverage based on current employment ends.If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.Required Notice: COBRA If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods. If you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to Human Resources. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, 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 www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changesTo protect your family’s rights, let the Plan Administrator know about 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• Human Resources OMB Control Number 1210-0123 (expires 1/31/2023)
Illinois Notice of Health Plan Coverage for Eligible Dependents Under the Age of 26As part of the federal Patient Protection and Affordable Care Act (more commonly known as Health Care Reform), dependents under the age of 26 — regardless of marital status — may be eligible for coverage under your employer sponsored health plan (medical, vision and/or dental benefits), if dependent coverage is offered.In addition, under Illinois law, any unmarried dependent child under 30 years of age is eligible for dependent coverage if the dependent meets all three (3) of the following conditions: i. is an Illinois resident,ii. served as an active or reserve member of any U.S. Armed Forces andiii. received release or discharge other than dishonorable dischargeEnrollees must submit to the insurer a form approved by the Illinois Department of Veterans’ Affairs stating the date on which the dependent was released from service. Please note your employer may require you to pay for all or part of the cost of your dependent’s health care coverage.For more information about plan eligibility, contact Human Resources.Patient Protection DisclosureUnited Healthcare generally requires the designation of a primary care provider on HMO and Nexus ACO plans. You have the right to designate any primary care provider who participates in the 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, contact UHC at 800-842-8000. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from United Healthcare 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, and is in the same medical group, 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, contact BCBSIL at 800-842-8000. Required Notices
11Important Notice: Prescription Drug Coverage and MedicareThis information is provided to analyze the possibility of joining a Medicare drug plan. Please compare current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage.There are 2 important things to consider about current coverage and Medicare’s prescription drug coverage: Medicare prescription drug coverage became available in 2006 to everyone with Medicare. An individual can get this coverage by joining a Medicare Prescription Drug Plan or by joining a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. The Company has determined that the prescription drug coverage offered by the health plan is, on average for all participants, expected to payout as much as standard Medicare prescription drug coverage. Therefore, the company’s benefits are considered Creditable Coverage and employees can keep the offered coverage and not pay a higher premium (a penalty) if they decide to join a Medicare drug plan.When can an individual join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15ththrough December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.What happens to an individual’s current coverage if they decide to join a Medicare drug plan? If you decide to join a Medicare drug plan, your current coverage will not be affected. Your current coverage pays for other health expenses in addition to prescription drugs. If you enroll in a Medicare prescription drug plan, you and your eligible dependents will still be eligible to receive all of your current health benefits. If you decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents may not be able to get this coverage back until the next annual enrollment.When will you pay a higher premium (penalty) to join a Medicare drug plan? If you drop or lose your current coverage and do not join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a high premium (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 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 19 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 (penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.Required Notice: Medicare Part DFor more information about the Medicare Part D Notice or current prescription drug coverage, please contact the Human Resources Department. For more information about your options under Medicare Prescription Drug Coverage please call the State Health Insurance Assistance Program at 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.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.govor call at 1-800-772-1213.Reminder: 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 (penalty).Contact InformationDate 4/1/24Name of Entity Morreale Real EstateContact Aaron RaffelAddress 455 Taft Ave., Glen Ellyn, IL 60137Phone Number 630-545-5316
Confidentiality Notice OneDigital Health and Benefits, a division of Digital Insurance, LLC does not sell or share any information we learn about our clients and understands you may have to answer sensitive questions about your medical history, physical condition and personal health habits as required by our insurance carrier partners.We collect nonpublic personal information from the following sources:• Information from you, including data provided on applications or other forms, such as name, address, telephone number, date of birth and Social Security number• Information from your transactions with us and/or our partners such as policy coverage, premium, claim, and payment history.OneDigital Health and Benefits recognizes the importance of safeguarding the privacy of our clients and prospective clients, and we pledge to protect the confidential nature of your personal information. We understand our ability to provide access to affordable health insurance to businesses and individuals can only succeed with an environment of complete trust.In the course of business, we may disclose all or part of your customer information without your permission to the following persons or entities for the following reasons:• To an insurance carrier, agent or credit reporting agency to detect, prevent or prosecute actual or potential criminal activity, fraud, misrepresentation, unauthorized transactions, claims or other liabilities in connection with an insurance transaction.• To a medical care institution or medical professional to verify coverage or benefits, to inform you of a medical problem of which you may or may not be aware or to conduct an audit that would enable us to verify treatment.• To an insurance regulatory authority, law enforcement or other governmental authority to protect our interests in detecting, preventing or prosecuting actual or potential criminal activity, fraud, misrepresentation, unauthorized transactions, claims or other liabilities in connection with an insurance transaction.• To a third party, for any other disclosures required or permitted by law. We may disclose all of the information that we collect about you, as described above.Our practices regarding information confidentiality and security: We restrict access to your customer information only to those individuals who need it to provide you with products or services, or to otherwise service your account. In addition, we have security measures in place to protect against the loss, misuse and/or unauthorized alternation of the customer information under our control, including physical, electronic and procedural safeguards that meet or exceed applicable federal and state standards.