• ISU A-Z
• MyISU
• CURRENT STUDENTS
• ALUMNI
• PARENTS
• FACULTY & STAFF

• Home
• Employment
• Forms/Policies
• Compensation
• Staff Benefits
• Training
• Contact Us

Human Resources Home / Staff Benefits / Important Notices and Changes

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.

Adult Children:

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 "Grandfathered plan".

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.

Privacy Notice:

Download Privacy Notice »
This notice describes how health Information about you may be used and disclosed. Please review it carefully.

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.

Special Enrollment:

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.

Grandfather Plan:

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 www.HealthCare.gov.

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, coverage for:

• 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: http://www.dol.gov/ebsa/publications/whcra.html

Office of Human Resources · Rankin Hall Room 300 · Indiana State University, Terre Haute, IN 47809
(812) 237-4114 · Fax: (812) 237-8331 · humanresources@indstate.edu
Hours: Monday - Friday · 8:00 AM - 4:30 PM

• Maps & Directions
• Contact Us
• Careers
• MyISU
• ISU A-Z

200 North Seventh Street, Terre Haute, Indiana, USA 47809-1902
Copyright © 2013 Indiana State University. 1-800-GO-TO-ISU | 1-800-468-6478 | Privacy Policy