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www.aptia365.com/horacemann 28 Copyright 2024 Aptia Insurance Services Group, LLC. All rights reserved.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) SPECIAL ENROLLMENT NOTICENotice of Special Enrollment Rights for Health Plan CoverageIf you have declined enrollment in Horace Mann%u2019s health plan for you or your dependents (including your spouse) because of other health insurance coverage, you or your dependents may be able to enroll in some coverages under these plans without waiting for the next Open Enrollment period, provided you request enrollment within 31 days after your other coverage ends.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 yourself and your eligible dependents, provided that you request enrollment within 31 days after the marriage, birth, adoption or placement for adoption.Horace Mann will also allow a special enrollment opportunity if you or your eligible dependents either:%u2022 Lose Medicaid or Children%u2019s Health Insurance Program (CHIP) coverage because you are no longer eligible, or%u2022 Become eligible for a state%u2019s premium assistance program under Medicaid or CHIP.For these enrollment opportunities, you will have 60 days %u2013 instead of 31%u2013 from the date of the Medicaid/CHIP eligibility change to request enrollment in the Horace Mann group health plan. Note that this 60-day extension does not apply to enrollment opportunities other than due to the Medicaid/CHIP eligibility change.Note: If your dependent becomes eligible for special enrollment rights, you may add the dependent to your current coverage or change to another medical plan.To request a HIPAA special enrollment based on the events described above or obtain more information, contact Jean Winn at 217-788-5108 or jean.winn@horacemann.com.WOMEN%u2019S HEALTH AND CANCER RIGHTS ACT (WHCRA) NOTICEIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women%u2019s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:%u2022 All stages of reconstruction of the breast on which the mastectomy was performed;%u2022 Surgery and reconstruction of the other breast to produce a symmetrical appearance;%u2022 Prostheses; and%u2022 Treatment of physical complications of the mastectomy, including lymphedema.These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your medical carrier at the phone number listed on the back of your ID card.NEWBORNS%u2019 AND MOTHERS%u2019 HEALTH PROTECTION ACT NOTICEGroup 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%u2019s or newborn%u2019s 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 96 hours). If you would like more information on maternity benefits, call your medical carrier at the phone number listed on the back of your ID card.MICHELLE%u2019S LAW NOTICEExtended Dependent Medical Coverage During Student Medical LeavesThe Horace Mann plan may extend medical coverage for dependent children if they lose eligibility for coverage because of a medically necessary leave of absence from a post-secondary educational institution (including a college or university). Coverage may continue for up to a year, unless the child%u2019s eligibility would end earlier for another reason.Extended coverage is available if a child%u2019s leave of absence from school %u2014 or change in school enrollment status (for example, switching from fulltime to part-time status) %u2014 starts while the child has a serious illness or injury, is medically necessary, and otherwise causes eligibility for student coverage under the plan to end. Written certification from the child%u2019s physician stating that the child suffers from a serious illness or injury and the leave of absence is medically necessary may be required.If the coverage provided by the plan is changed during this one-year period, the plan will provide the changed coverage for the remainder of the leave of absence.If your child will lose eligibility for coverage because of a medically necessary leave of absence from school and you want his or her coverage to be extended, call Aptia365 at 855-408-4388 as soon as the need for the leave is recognized by Horace Mann. In addition, contact your child%u2019s health plan to see if any state laws requiring extended coverage may apply to his or her benefits.