ANNUAL NOTICES TO ALL MCSIG PLAN PARTICIPANTS

MCSIG provides the following annual notices regarding the Health Insurance Portability and Accountability Act (HIPAA) and the Women s Health and Cancer Rights Act (WHCRA) so that our members are well informed of the provisions of each Act.

MCSIG has elected to be exempt from the required provisions of HIPAA. However, all of our plans still substantially comply with the provisions of HIPAA. This allows MCSIG flexibility in providing cost effective services to participants and reduces the administrative expenses associated with federal regulatory compliance.

The MCSIG medical plans have always been in compliance with the Women s Health and Cancer Rights Act provisions, even prior to its enactment, and MCSIG continues to provide these benefits.

Health Insurance Portability and Accountability Act - HIPAA

Under a Federal law known as the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191, as amended, group health plans must generally comply with the requirements listed below. However, the law also permits State and local governmental employers that sponsor health plans to elect to exempt a plan from these requirements for any part of the plan that is  self-funded by the employer, rather than provided through a health insurance policy. Monterey County Schools Insurance Group (MCSIG) has elected to exempt all medical plans and all dental and vision plans from all of the following requirements:

1. Limitations on preexisting condition exclusion periods. A preexisting condition exclusion period generally may not exceed 12 months, and generally must be reduced by prior health coverage an individual has had. Also, a plan may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition, nor, under certain conditions, with respect to newborns or children adopted or place for adoption.
2. Special enrollment periods. Group health plans are required to provide special enrollment periods for individuals who do not enroll in the plan because they have other coverage, but subsequently lose that coverage. Also, if a plan provides dependent coverage, the plan must provide a special enrollment period for new dependents (and the employee if not already enrolled) within 30 days after a marriage, birth, adoption or placement for adoption.
3. Prohibitions against discriminating against individual participants and beneficiaries based on health status. A group health plan may not discriminate in enrollment rules or in the amount of premiums or contributions it requires an individual to pay based on certain health status-related factors: health status, medical condition (physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability.
4. Standards relating to benefits for mothers and newborns. Group health plans offering health coverage for hospital stays in connection with the birth of a child generally may not restrict benefits for the stay to less than 48 hours for a vaginal delivery, and 96 hours for cesarean section.
5. Parity in the application of certain limits to mental health benefits. Group health plans (of employers that employ more than 50 employees) offering mental health benefits may not set annual or lifetime dollar limits on mental health benefits that are lower than limits for medical and surgical benefits. A plan that does not impose an annual or lifetime dollar limit on medical and surgical benefits may not impose that type of limit on mental health benefits. These requirements do not apply to benefits for substance abuse or chemical dependency.
6. Required coverage for reconstructive surgery following mastectomies. Group health plans that provide medical and surgical benefits for a mastectomy must provide certain benefits in connection with breast reconstruction as well as certain other related benefits.
   

The exemption from these Federal requirements is in effect for the plan year beginning July 1, 2008 and ending June 30, 2009. The election may be renewed for subsequent plan years.

HIPAA also requires the Plan to provide covered employees and dependents with a certificate of creditable coverage when they cease to be covered under the Plan. There is no exemption from this requirement. This certificate provides evidence that you were covered under this Plan, because if you can establish your prior coverage, you may be entitled to certain right to reduce or eliminate a preexisting condition exclusion if you join another employer s health plan, or if you wish to purchase an individual health insurance policy.

Women s Health and Cancer Rights Act - WHCRA

The Women s Health and Cancer Rights Act (WHCRA) of 1998 requires group health plans that provide medical benefits for mastectomies to also provide coverage for the following related procedures to a participant or beneficiary who is receiving medical benefits for a mastectomy. This includes:

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

The MCSIG medical plans continue to provide coverage for mastectomies and the related procedures listed above, subject to the health plan s usual deductible and coinsurance limitations. This notice is intended to notify you of your rights and to comply with the notice requirements of the Women s Health and Cancer Rights Act of 1998. If you have any questions, please refer to your Summary Plan Description or contact MCSIG Customer Service at (831) 755-8055 or (800) 287-1442.