Page 21 - Enrollment-Guide-2026-27-Final

Required Notices Required Notices

Summary of Benefits and Coverage Special Enrollment Women’s Health and Cancer Rights

As an employee, the group health (medical) benefits If you are declining enrollment for yourself or your Act (WHCRA)
available to you represent a significant component dependents (including your spouse) because of other
of your compensation package. The medical benefits health insurance or group health plan coverage, you If you have had or are going to have a mastectomy,
also provide important protection for you and your may be able to enroll yourself and your dependents you may be entitled to certain benefits under the
family in the case of illness or injury. Choosing a in this plan if you or your dependents lose eligibility Women’s Health and Cancer Rights Act of 1998
health coverage option is an important decision. To for that other coverage (or if the employer stops (WHCRA). For individuals receiving mastectomy-
help you make an informed choice, SchoolCare contributing toward your or your dependents’ other related benefits, coverage will be provided in
makes available a Summary of Benefits and Coverage coverage). However, you must request enrollment a manner determined in consultation with the
(SBC) which summarizes important information about within 30 days after your or your dependents’ other attending physician and the patient, for:
any health coverage option in a standard format to coverage ends (or after the employer stops contributing • All stages of reconstruction of the breast on
help you compare across options. The SBC is available toward the other coverage). which the mastectomy was performed;
at schoolcare.org/resources-documents. A paper copy • Surgery and reconstruction of the other breast
is also available, free of charge, by calling your Human If you have a new dependent as a result of marriage, produce a symmetrical appearance;
Resources Office. Please note the Subscriber is birth, adoption, or placement for adoption, you may be • Prostheses; and
responsible for providing a copy to their dependents able to enroll yourself and your dependents. However, • Treatment of physical complications of the dependents might be eligible for these programs,
covered under the group health plan. you must request enrollment within 30 days after the contact your State Medicaid or CHIP office or dial
marriage, birth, adoption, or placement for adoption. mastectomy, including lymphedema. 877-KIDS NOW or insurekidsnow.gov to find out
how to apply. If you qualify, ask your state if it has a
Special Provisions for Employers with To request special enrollment or obtain more These benefits will be provided subject to the same program that might help you pay the premiums for

Section 125 Plans information, please contact your Human Resources deductible and coinsurance applicable to other an employer-sponsored plan.
Office or SchoolCare at 603-836-5031. medical and surgical benefits provided under the
By allowing an individual to enroll in the Insurance plan. If you would like more information on WHCRA If you or your dependents are eligible for premium
Plan other than during the open enrollment period, benefits, call Cigna at 800-244-6224. assistance under Medicaid or CHIP, as well as eligible
SchoolCare, Cigna Healthcare or Cigna Health and No Surprise Medical Bills under your employer plan, your employer must
Life Insurance Company do not waive any terms of its Premium Assistance Under Medicaid allow you to enroll in your employer plan if you
contracts. Further, by allowing an individual to enroll Federal law now provides special rights and protections aren’t already enrolled. This is called a “special
in the Insurance Plan other than during the open against surprise bills and balance billing. Effective and the Children's Health Insurance enrollment” opportunity, and you must request
enrollment period, SchoolCare, Cigna Healthcare January 1, 2022, this law provides protection from Program (CHIP) coverage within 60 days of being determined eligible
or Cigna Health and Life Insurance Company do unexpected bills from out-of-network providers seen for premium assistance. If you have questions
not thereby express any opinion regarding the during an emergency or as part of a visit at an in- If you or your children are eligible for Medicaid or about enrolling in your employer plan, contact the
appropriateness of the change under Section 125 network hospital or ambulatory surgical center. CHIP and you’re eligible for health coverage from Department of Labor at askebsa.dol.gov or call 866-
of the Internal Revenue Code or the terms of the Read more here. your employer, your state may have a premium 444-EBSA (3272).
employer's Section 125 plan. assistance program that can help pay for coverage, To see if your state has a premium assistance

Wellness Programs using funds from their Medicaid or CHIP programs. program, or for more information on special
If you or your children aren’t eligible for Medicaid
Your health plan is committed to helping you achieve or CHIP, you won’t be eligible for these premium enrollment rights, contact either:
your best health. Incentives for participating in a assistance programs but you may be able to buy • U.S. Department of Labor
wellness program are available to all Subscribers. If you individual insurance coverage through the Health
are unable to participate in any of the health-related Insurance Marketplace. For more information, visit Employee Benefits Security Administration
activities to earn an incentive, you may be entitled to a healthcare.gov. dol.gov/agencies/ebsa
reasonable accommodation or an alternative standard. If you or your dependents are already enrolled in 866-444-EBSA (3272)
You may request a reasonable accommodation or an Medicaid or CHIP, contact your State Medicaid or
alternative standard by contacting SchoolCare’s CHIP office. • U.S. Department of Health and Human Services
health management provider, Cigna at 800-244-6224. Centers for Medicare & Medicaid Services
View the complete notice and learn more about your If you or your dependents are NOT currently enrolled cms.hhs.gov
Protection of the Disclosure of Medical Information. in Medicaid or CHIP, and you think you or any of your 877-267-2323, Menu Option 4, Ext. 61565

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