Page 28 - Venafi - 2021 Benefit Guide - CA

general participation guidelines and notices

Important notice The coverage examples will illustrate sample medical If you qualify, ask your state if it has a program that
The benefit summaries contained in this guide are situations and describe how much coverage the plan might help you pay the premiums for an employer-
for ease of comparison. This guide provides only a would provide. The SBC will be posted on the employee sponsored plan. If you or your dependents are eligible for
summary of benefits available to eligible employees website. If you would like a paper copy of this summary, premium assistance under Medicaid or CHIP, as well as
and their dependents. The information in this guide please contact HR. eligible under your employer plan, your employer must
supersedes all prior guides. However, since this guide is allow you to enroll in your employer plan if you aren’t
only a summary, it does not describe every detail of the Waiving coverage already enrolled.
benefit programs outlined. If there are inconsistencies If you and/or your dependents have appropriate benefits This is called a “special enrollment” opportunity, and
or discrepancies between this guide and the governing from an alternate source, you may choose to waive you must request coverage within 60 days of being
plan documents and benefit contracts, the governing coverage. determined eligible for premium assistance. If you have
plan documents and benefit contracts will control. If you are declining enrollment for yourself and/or your questions about enrolling in your employer plan, contact
The governing plan documents and benefit contracts dependents (including your spouse) because of other the Department of Labor.
are available for your review in the Human Resources coverage, you may be able to enroll yourself and/or
Department. your dependents in this plan in the future, providing Utah Medicaid and CHIP Information

Refer to the carrier’s literature for specific details. No that you request enrollment within 30 days after your health.utah.gov/upp
rights shall accrue to you and/or your dependents other coverage ends and can provide supporting 1 (866) 435-7414
because of any statement, error, or omission in this documentation. Children’s medical coverage assistance
comparison. Reasonable efforts are made to keep health.utah.gov/chip
employees apprised of any changes in benefit plans Medical coverage assistance options 1 (877) KIDS-NOW
including medical, dental, vision, life and AD&D, If you or your children are eligible for Medicaid or Low-income family medical coverage assistance
voluntary life, short-term disability (STD), long-term CHIP and you’re eligible for health coverage from your medicaid.utah.gov
disability (LTD), Health Savings Account (HSA), and employer, your state may have a premium assistance 1 (801) 538-6155
Flexible Spending Accounts (FSA). program that can help pay for coverage, using funds
Venafi may choose to communicate certain plan from their Medicaid or CHIP programs. If you or your Health Insurance Marketplace
healthcare.gov
documents and benefits information electronically to children aren’t eligible for Medicaid or CHIP, you won’t 1 (800) 318-2596
participants. You may obtain copies of these documents, be eligible for these premium assistance programs but
upon written request, from Human Resources. you may be able to buy individual insurance coverage
through the Health Insurance Marketplace. For more
Summary of benefits coverage information, visit healthcare.gov.
As a result of the Affordable Care Act (the health care If you or dependents are already enrolled in Medicaid or
reform law) all health insurance issuers are required to CHIP, contact your State Medicaid or CHIP office to find
provide a Summary of Benefits Coverage (SBC). The out if premium assistance is available.
SBC has a uniform glossary of terms commonly used If you or your dependents are NOT currently enrolled
in health insurance coverage and also uses a new, in Medicaid or CHIP, and you think you or any of your
standardized plan comparison tool called “coverage dependents might be eligible for either of these
examples,” similar to the Nutrition Facts label required programs, contact your State Medicaid or CHIP office or
for packaged foods.
dial 1-877-KIDS-NOW or insurekidsnow.gov to find out
how to apply.
25
25