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Important Notices and Changes
Lifetime and Annual Limits:
Affordable Care Act prohibits health plans from putting a "lifetime" dollar limit on most benefits you
receive. The act also restricts the "annual" dollar limits a health plan can place on most of your benefits.
Effective January 1, 2011, all annual and lifetime limits on the dollar value of benefits under ISU's health
plan will no longer apply. Individuals whose coverage ended by reason of reaching a lifetime limit under the
plan are eligible to enroll in the plan.
Individuals whose coverage ended, or who were denied coverage, or were not eligible for coverage, because
the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in
ISU's health plan. Individuals may request enrollment for such children during Open enrollment each year or,
with a qualifying event, through "Special Enrollment". Children are eligible to stay on the plan until the
end of the year they attain age 26 or for Grandfathered plans before January 1, 2014, until they become
eligible to enroll in another employer-sponsored health plan (which ever comes first). ISU is a
Children & Pre-existing Conditions:
Under the Affordable Care Act, health plans cannot limit or deny benefits or deny coverage for a child
younger than age 19 simply because the child has a pre-existing condition. The pre-existing limitation on
ISU's health plan will no longer apply to children younger than age 19.
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This notice describes how health Information about you may be used and disclosed. Please review it
Medicaid and the Children's Health Insurance Program (CHIP):
If you are eligible for health coverage from your employer but are unable to afford the premiums, some
states have premium assistance programs that can help pay for coverage. These states use funds from their
Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need
assistance in paying their health premiums.
More Information »
Notice of Pre-existing Condition Exclusion:
ISU's health plan imposes a pre-existing condition exclusion. This means that if you have a medical
condition before coming to our plan, you might have to wait a certain period of time before the plan will
provide coverage for that condition. This exclusion applies only to conditions for which medical advice,
diagnosis, care, or treatment was recommended or received within a 6-month period prior to the effective
date of your coverage. The pre-existing condition exclusion does not apply to pregnancy nor to a child
who is enrolled in the plan within 30 days after birth, adoption, or placement for adoption, or to children
under the age of 19.
The exclusion last up to 12 months from your first day of coverage. However you can reduce the length of
this exclusion period by the number of days of your prior "creditable coverage." Most prior health coverage is
creditable coverage and can be used to reduce the pre-existing condition exclusion if you have not experienced
a break in coverage of at least 63 days. To reduce the 12-month exclusion period by your creditable coverage,
you should give Staff Benefits a copy of any certificates of creditable coverage you have. If you do not have
a certificate, but you do have prior health coverage, you should obtain one from your prior plan or issuer.
All questions about the pre-existing condition exclusion and creditable coverage should be directed to Staff
Benefits, Rankin 300, or call ext 4150.
If you have declined enrollment for yourself or your dependents (including your spouse) because of other
health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in
ISU's plan if you or your dependents lose eligibility for that other coverage (or if the employer stops
contributing toward your or your dependents' other coverage). However, you must request enrollment within
30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward
the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for
adoption, you may be able to enroll your dependents. However, you must request enrollment within 30 days
after the marriage, birth, adoption or placement for adoption.
Finally, you and/or your dependents may have special enrollment rights if coverage is lost under Medicaid
or a State health insurance (SCHIP) program, or when you and/or your dependents gain eligibility for state
premium assistance. You have 60 days from the occurrence of one of these events to notify Staff Benefits
and enroll in the plan.
Special Enrollment Application »
To request special enrollment or obtain more information, contact Staff Benefits, 300 Rankin Hall or call ext. 4150.
This health coverage is a "grandfathered health plan" under the Patient Protection and Affordable Care Act.
As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage
that was already in effect when that law was enacted.
Being a grandfathered health plan means that this health plan may not include certain consumer protections
of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of
preventive health services without any cost sharing. However, grandfathered health plans must comply with
certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime
limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health
plan and what might cause a plan to change from grandfathered health plan status can be directed to Staff
Benefits, 300 Rankin, ext 4150. You may also contact the U.S. Department of Health and Human Services at
Newborn's and Mother's Health Protection Act (NMHPA):
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for
any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48
hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal
law generally does not prohibit the mother's or newborn's attending provider, after consulting with the
mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In
any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from
the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96hours).
Women's Health and Cancer Rights Act:
Under Federal law, Group Health Plans and health insurance issuers providing benefits for mastectomy must
also provide, in connection with the mastectomy for which the participant or beneficiary is receiving benefits,
- reconstruction of the breast on which the mastectomy has been performed;
- surgery and reconstruction of the other breast to produce a symmetrical appearance;
- prostheses and physical complications of mastectomy, including lymphedemas;
These services must be provided in a manner determined in consultation between the attending Physician
and the patient. For more information regarding your rights after a mastectomy go to: