Page 29 - Venafi - 2021 Benefit Guide - CA

general participation guidelines and notices

ACA notices about eligibility and Women’s health and cancer rights act Also, a health insurer or HMO cannot require you or
coverage periods enrollment notice your attending provider to obtain prior authorization
for your delivery or show that the 48-hour (or 96-hour)
• Venafi has adopted a 12 month “initial measurement If you have had or are going to have a mastectomy, you stay is medically necessary. However, a health insurer or
period” and 12 month stability period for all new may be entitled to certain benefits under the Women’s HMO may require you to get prior authorization for any
part-time, variable hour, and seasonal employees Health and Cancer Rights Act of 1998 (WHCRA). For portion of stay after the 48 hours (or 96 hours).
which begins as of the date of employment/start individuals receiving mastectomy-related benefits,
date for each new employee in these categories. coverage will be provided in a manner determined Privacy policy
The administrative period for such new part-time, in consultation with the attending physician and the Summary of privacy practices
variable hour, or seasonal employees who measure patient, for: This Summary of Privacy Practices summarizes how
full-time in their initial measurement period is • All stages of reconstruction of the breast on which medical information about you may be used and
approximately 30 days depending on whether you the mastectomy was performed; disclosed in the administration of your claims, and of
started your job on the 1st of the month or in the certain rights you have.
middle of the month. • Surgery and reconstruction of the other breast to
produce a symmetrical appearance; Our pledge regarding medical information
• You are being offered the opportunity to enroll The company is committed to protecting your personal
yourself and your dependents (if any) in Venafi’s • Prostheses; and health information. As required by law, we:
health plan because you were either hired as a full- • Treatment of physical complications of the
time employee or you have measured as full-time mastectomy, including lymphedema. 1. make sure that any medical information that
during a given, applicable measurement period. identifies you is kept private;
These benefits will be provided subject to the same
• If you “waive” or “decline” coverage then you may deductibles and coinsurances applicable to other 2. provide you with rights with respect to your medical
be prevented from qualifying for a premium tax medical and surgical benefits provided under this plan. information;
credit or cost share reduction subsidy for coverage 3. give you a notice of our legal duties and privacy
you may purchase for yourself or your dependents Newborns’ and Mothers’ Health practices; and
on the health insurance marketplace/exchange Protection Act
applicable to your state of residence, which may be 4. follow all privacy practices and procedures currently
the federal health insurance marketplace/exchange. The Newborns’ and Mothers’ Health Protection Act of in effect.
1996 (NMHPA) affects the amount of time you and your
• If you choose to enroll in coverage, the coverage newborn child are covered for a hospital stay following How the company may use and disclose medical
period is 12 months. Federal law and Venafi’s childbirth. In general, health insurers and Health information about you
cafeteria plan provide very limited situations in Maintenance Organizations (HMOs) may not restrict Any use and disclosure of your medical information
which you will be allowed to dis-enroll in healthcare benefits for a hospital stay in connection with childbirth requires your written authorization. Your personal health
coverage during your 12-month coverage period. to less than 48 hours following a vaginal delivery or 96 information may be used and disclosed without your
Therefore, if you change your mind after your hours following a delivery by cesarean section. If you permission to facilitate your medical treatment, for
coverage begins, you will not be allowed to cancel deliver in the hospital, the 48-hour (or 96-hour) period payment of any medical treatments, and for any other
your coverage unless you meet one of the situations starts at the time of delivery. health care operation. Your personal health information
allowed by law or in our plan. may be disclosed without your permission as allowed
If you deliver somewhere other than the hospital and you or required by law. You cannot be retaliated against
are later admitted to the hospital in connection with the if you refuse to sign an authorization or revoke an
childbirth, the period begins at the time of admission.
authorization you had previously given.

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