HIPAA Notice

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 some of 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

Group health plans sponsored by state and local governments must generally comply with the Federal law requirements in Title XXVII of the Public Health Service Act. However, these plans are permitted to elect to exempt a plan from theses 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 self-funded medical plans and all dental and vision plans from all of the following requirements:

1. 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.
2. 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.
3. 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 January 1, 2012. 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.