Wawasee Community School Corporation

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer,
your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or
CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium
assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace.
For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your
State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents
might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or
www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you
pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your
employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is
called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible
for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor
at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

CHIP Notice

Health Insurance Marketplace Coverage Options and Your Health Coverage

Beginning in 2014, there is a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards.

If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5 percent (as adjusted each year after 2014) of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. (An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.)

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution—as well as your employee contribution to employer-offered coverage—is often excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, as well as an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

Women’s Health and Cancer Rights Act of 1992 (WHCRA)

2024 ENROLLMENT NOTICE

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s 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: 

• All stages of reconstruction of the breast on which the mastectomy was performed; 
• Surgery and reconstruction of the other breast to produce a symmetrical appearance; 
• Prostheses; and 
• 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 plan administrator (800-323-1683).

2024 ANNUAL NOTICE

Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? Call your plan administrator at (800-323-1683) for more information.

MEDICARE D ONLINE COMPLIANCE WITH CMS

Background

• Jan 2005: Federal guidance announced for employers to give Prescription Drug Creditable Coverage Notices to Medicare-eligible employees before Nov 15, 2005.

• Jan 2006: Additional guidance announced for employers to provide a Disclosure Notice to CMS.

Who Must Provide the Disclosure Notice to CMS

All group health plans that provide prescription drug benefits to Medicare-eligible employees, including:

• Employer group health plans

• Union and TAFT-Hartley plans

• Church plans

• Federal, State, and local government plans

• Other group-sponsored plans

When Disclosure to CMS Must Be Made

The Disclosure Notice must be made:

1. Annually (within 60 days after the start of the plan year)

2. When coverage changes to affect creditable status

3. Within 30 days after:

   • Termination of the prescription drug plan

   • Change in creditable coverage status

Special Note for Past Years:

• Plan years ending in 2006: Due March 31, 2006

• Plan years 2007 and beyond: Due within 60 days of plan year start

How to Provide Disclosure to CMS

• Complete the Disclosure Form on the CMS Creditable Coverage Disclosure Web Page:

• This is the only method for compliance.

• It is quick and convenient to complete.

Information Needed for the Disclosure Notice

1. Name of entity providing coverage

2. Federal tax identification number*

3. Address of entity

4. Phone number of entity

5. Type of coverage provided

6. Number of prescription drug options offered

7. Creditable coverage status for each prescription drug plan option

8. Period covered by the Disclosure Notice

9. Estimated number of Medicare Part D eligible individuals covered at the beginning of the plan year

10. Estimated number of Medicare Part D retirees covered at the beginning of the plan year

11. Date the notice of creditable coverage was provided to Medicare-eligible individuals

12. Name, title, and email address of authorized representative completing form

13. Date of the Disclosure Notice to CMS

*For plans with subsidiaries, use only the parent entity’s federal tax ID number.