Federal law allows for special enrollment rights to permit you to elect coverage or add dependents. This would occur in the case of marriage, birth, adoption, or placement for adoption of a child, or loss of other coverage. However, you must provide written notice to the Human Resources/Benefits Department within 31 days of the marriage, birth, adoption, or loss of other coverage to elect benefit(s) coverage.
If you decline enrollment for yourself or your dependents (including your spouse) because of other health benefit coverage, you may be able to enroll yourself or your dependents in LG Health’s plans in the future, provided that you request enrollment within 30 days after your other coverage ends.
Special enrollment can be requested only after losing eligibility for the other coverage, after employer premiums for the other coverage stops, or after exhausting COBRA coverage in effect, when you declined coverage. An individual does not have special enrollment rights if the loss of coverage is the result of the failure to pay premiums or if employment is terminated for gross misconduct reasons.
The Women’s Health and Cancer Rights Act requires that group Health Plans provide the following services to any person receiving benefits in connection with a mastectomy:
If you receive benefits from a Health Insurance Plan for a mastectomy and you then elect to have reconstructive surgery, the Plan must provide coverage in a manner determined in consultation with the attending physician and the patient. The benefits for breast reconstruction and related services will be the same as the benefit that applies to other services covered by your Plan. It is important to note that the Plan covers these expenses and the law requires that we provide this notice each year.
Group health plans 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 to 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 issuer for lengths of stay of less than 48 hours (or 96 hours).
Employees and dependents who were eligible for health care coverage in the LG Consumer or LG Select Plan, but are not enrolled, will be permitted to enroll in the plan if they lose eligibility for Medicaid or CHIP (Children’s Health Insurance Program) coverage or become eligible for a premium assistance subsidy under Medicaid or CHIP.
Individuals must request coverage within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy.
CHIPRA (Children’s Health Insurance Reauthorization Act of 2009) allows states to offer eligible low income children and their families a premium assistance subsidy to help pay for employer-sponsored coverage.
If you have questions regarding CHIPRA, please do not hesitate to contact the Lancaster General Health Benefits Team at 717-544-1177.
This summary provides only a brief overview of the LG Consumer and LG Select Plans’ health privacy practices.
LG Health has issued a Health Privacy Notice that describes how health information about you may be used and disclosed by the LG Health Plans and how you can get access to your information. You should keep a copy of the Health Privacy Notice you received and review it carefully because it describes the Plans’ privacy practices in more detail.
How the Health Programs Will Use Your Information
The Health Plans may use, share, or disclose the personal health information they create, receive, or maintain about you (“protected health information”) for purposes relating to the payment of medical insurance, operation of the Plans, or treatment by a health care provider. The Plans may use or disclose your information in other special circumstances described in the Health Privacy Notice. For any other purpose, the Plan requires your written authorization for the use or disclosure of your protected health information.
Your Individual Rights
You have the right to inspect and copy certain protected health information, request an amendment of the information, request restrictions on the use and disclosure of the information, request that communications be made to you through alternate means or at an alternative location, and obtain an accounting of the information that a Plan has disclosed (with certain notable exceptions, including disclosures for treatment, payment, or certain operational purposes, as well as disclosures to you or disclosures that you authorize). There are certain limitations on these rights as explained in the original Health Privacy Notice.
Questions and Concerns
If you would like more information about the Plans’ privacy practices, or if you feel that your protected health information was mishandled or your privacy rights under HIPAA were violated, you may contact the LG Health Plans HIPAA Privacy Officer at 717-544-4578.
If you believe your privacy rights have been violated, you can file a formal complaint with the LG Health Plans HIPAA Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights at 1-800-368-1019. You will not be penalized for filing a complaint.
You may also make a written request to inspect, copy, or amend protected health information—or for an accounting of disclosures—and submit it to the LG Health Plans HIPAA Privacy Officer. To request an additional paper copy of the detailed Health Privacy Notice, contact the LG Health Plans HIPAA Privacy Officer.
HIPAA Notice and Forms:
HIPAA Privacy Notice
Privacy Notice Election Change Form
Authorization To Use PHI Form
Request to Amend Disclosures of PHI Form
Request to Restrict Disclosures of PHI Form
Request to Access Disclosures of PHI Form
HIPAA Complaint Form
At Lancaster General Health, we strive to provide our employees and their dependents with quality health insurance. Key provisions of the Patient Protection and Affordable Care Act (PPACA) require us to provide you with this Notice to inform you of our compliance with the law and to make you aware of your options in the Health Insurance Marketplace.
What We Have Done to Ensure Compliance with PPACA
As a result of the PPACA, several new legal requirements apply to group health plans offered by many employers. These include:
We have worked to ensure that the plans we offer meet these standards established by the new law. Our goal is to continue to have employee contributions for employee only coverage that will not exceed 9.5% of the employee’s annual gross earnings and the plan’s share of the total allowed benefit costs covered by the plan, will be no less than 60% of those costs.
Although our group health plans offer quality insurance at affordable rates, we recognize that some employees may want to explore other insurance options on the “Marketplace” or “Exchange”. This next section will provide a description of the Marketplace and how participating in it may affect your rights under our health plan, so that you may weigh your options.
What is the Health Insurance Marketplace?
The Marketplace is designed to help individuals find health insurance that meets their needs and fits their budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. Individuals may also be eligible for a new kind of tax credit (if certain criteria are met) that can lower their monthly premium for coverage purchased through the Marketplace.
Can Someone Save Money on Health Insurance Premiums in the Marketplace?
Individuals may qualify for tax credits that will enable them to save money and lower monthly premiums for coverage purchased through the Marketplace, but only if their employer does not offer coverage, or offers coverage that doesn’t meet certain standards. As noted above, we have worked to ensure that the plans we offer meet these standards established by the new law. Therefore, we do not believe that our benefit eligible employees will qualify for tax credits to purchase coverage in the Marketplace. For individuals who qualify, the amount of their tax credit will depend on household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If an individual’s employer offers health coverage that meets certain standards, the individual will not be eligible for a tax credit through the Marketplace and may wish to enroll in the employer’s health plan. However, tax credits that lower monthly premiums or a reduction in certain cost-sharing may be available if an employer does not offer coverage at all or does not offer coverage that meets certain standards. If the cost of an employer’s plan for individuals only (and not any other members of their family) is more than 9.5% of an employee’s household income for the year, or if the employer-provided coverage does not meet the “minimum value” standard set by the PPACA, an individual may be eligible for a tax credit.
Note: If you purchase a health plan through the health insurance Marketplace instead of accepting health coverage that we offer, then you will lose employer contributions to the employer offered coverage. Also, you will not be able to participate in the plan until the next open enrollment period, unless a qualifying life event occurs.
For More Information
For more information about your coverage offered by your employer, please check your Summary Plan Description, Summary of Benefits and Coverage, or contact the HR Benefits department at (717) 544-1177.
For more information on the Marketplace, including your eligibility for coverage through the Marketplace and its costs, visit HealthCare.gov. Information available there includes an online application for health insurance coverage and contact information for a Health Insurance Marketplace in Pennsylvania.
The Patient Protection and Affordable Care Act (PPACA) requires all organizations to report the cost of employer-sponsored health coverage to their employees on IRS Form W-2.
The purpose of the reporting requirement is “to provide useful and comparable consumer information to employees on the cost of their health care coverage.” The notice also states that there is nothing that will cause the employer-sponsored health coverage to become taxable.
This includes the portion of the cost paid by the employer and the portion of the cost paid by the employee. The reportable cost of group health coverage will be listed in Box 12 on form W-2 with CODE DD.
Basic Leave Entitlement
FMLA requires LG Health to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons:
The Patient Protection Eligible employees with a spouse, son, daughter or parent on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions and attending post-deployment reintegration briefings.
FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered servicemember during a single 12-month period. A covered servicemember is a current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of duty on active duty that may render the servicemember medically unfit to perform his or her duties for which the servicemember is undergoing medical treatment, recuperation or therapy; or is in outpatient status; or is on the temporary disability retired list.
Annual Required Notices
Benefits and Protections
During FMLA leave, LG Health must maintain the employee’s health coverage under any “group health plan” on the same terms as if the employee had continued to work. Upon return from FMLA, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms.
Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee’s leave.
Employees are eligible if they have worked for LG Health for at least one year, for more than 1,250 hours over the previous 12 months.
Definition of Serious Health Condition
A serious health condition is an illness, injury, impairment or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee’s job, or prevents the qualified family member from participating in school or other daily activities.
Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than 3 consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment.
Use of Leave
An employee does not need to use this leave entitlement in one block. Leave can be taken intermittently or on a reduced leave schedule when medically necessary. Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer’s operations. Leave due to qualifying exigencies may also be taken on an intermittent basis.
Pay During Leave
Employees are required to use accrued paid leave while taking FMLA leave. When using paid leave for FMLA, employees must comply with the employer’s normal paid leave policies.
Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with LG Health’s normal call-in procedures.
Employees must provide sufficient information to LG Health for determining if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave. Employees also must inform LG Health if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave.
LG Health must inform employees requesting leave whether they are eligible under FMLA. If they are, the notice must specify any additional information required as well as the employee’s rights and responsibilities. If they are not eligible, LG Health must provide a reason for the ineligibility.
LG Health must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee’s leave entitlement. If the employer determines that the leave is not FMLA-protected, LG Health must notify the employee.
FMLA makes it unlawful for LG Health to:
FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law which provides greater family or medical leave rights.
Affordable Care Act Section 1557 Notice
Lancaster General Health/Penn Medicine complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. LG Health/Penn Medicine does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
LG Health/Penn Medicine:
If you need these services, contact Jennifer Zeiders at 717-544-4578.
If you believe that LG Health/Penn Medicine has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Jennifer Zeiders, Benefits Manager
555 N Duke Street, PO BOX 3555
Lancaster, PA 17604
717-544-4578, Fax 717-544-1351
Or email at JZeiders2@lghealth.org
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Jennifer Zeiders is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)