Benefit Updates
for 2014


 

Glossary of Health Coverage and Medical Terms (click here)

Credible Coverage

SAR Summary Annual Report



TeamstersCare –
A Grandfathered Plan under the Affordable Care Act

Teamsters Union 25 Health Services & Insurance Plan (TeamstersCare ) believes that it is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the 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 TeamstersCare 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 TeamstersCare Executive Director, Dr. Carol Blanchard at 617-241-9220. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.


Early Retiree Reinsurance Program

Notice about the Early Retiree Reinsurance Program
You are a plan participant, or are being offered the opportunity to enroll as a plan participant, in an employment-based health plan (TeamstersCare) that is certified for participation in the Early Retiree Reinsurance Program (ERRP).  The Early Retiree Reinsurance Program is a Federal program that was established under the Affordable Care Act. Under the Early Retiree Reinsurance Program, the Federal government reimburses a plan sponsor of an employment-based health plan for some of the costs of health care benefits paid on behalf of, or by, early retirees and certain family members of early retirees participating in the employment-based plan. By law, the program expires on January 1, 2014.

Under the Early Retiree Reinsurance Program, TeamstersCare may choose to use any reimbursements it receives from this program to reduce or offset increases in early retiree plan participants’ premium contributions, co-payments, deductibles, co-insurance, or other out-of-pocket costs. If TeamstersCare chooses to use the Early Retiree Reinsurance Program reimbursements in this way, you, as a plan participant, may experience changes that may be advantageous to you, in your health plan coverage terms and conditions, for so long as the reimbursements under this program are available and TeamstersCare chooses to use the reimbursements for this purpose. TeamstersCare may also use the Early Retiree Reinsurance Program reimbursements to reduce or offset increases in its own costs for maintaining your health benefits coverage, which may increase the likelihood that it will continue to offer health benefits coverage to its retirees and employees and their families.


Medicaid and the Children’s Health Insurance Program (CHIP)
Offer Free Or Low-Cost Health Coverage To Children And Families

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage.  These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs.
           
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can 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, you can 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, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. 

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP,  as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not 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, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 1-866-444-EBSA (3272).

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums.  The following list of States is current as of July 31, 2012.  You should contact your State for further information on eligibility –

 

ALABAMA – Medicaid

COLORADO – Medicaid

Website:
http://www.medicaid.alabama.gov

Phone: 1-855-692-5447

 

Medicaid Website:
http://www.colorado.gov/

Medicaid Phone (In state): 1-800-866-3513

Medicaid Phone (Out of state): 1-800-221-3943

 

 

ALASKA – Medicaid

Website: http://health.hss.state.ak.us/dpa/programs/medicaid/

Phone (Outside of Anchorage): 1-888-318-8890

Phone (Anchorage): 907-269-6529

 

ARIZONA – CHIP

FLORIDA – Medicaid

Website:
http://www.azahcccs.gov/applicants

Phone (Outside of Maricopa County): 1-877-764-5437

Phone (Maricopa County): 602-417-5437

 

 

 

 

Website:
https://www.flmedicaidtplrecovery.com/

Phone: 1-877-357-3268

 

GEORGIA – Medicaid

Website:
http://dch.georgia.gov/

Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP)

Phone: 1-800-869-1150

IDAHO – Medicaid and CHIP

MONTANA – Medicaid

Medicaid Website: www.accesstohealthinsurance.idaho.gov

Medicaid Phone: 1-800-926-2588

CHIP Website:
www.medicaid.idaho.gov

 

CHIP Phone: 1-800-926-2588

 

Website: http://medicaidprovider.hhs.mt.gov/clientpages/
clientindex.shtml

Phone: 1-800-694-3084

 

 

INDIANA – Medicaid

NEBRASKA – Medicaid

Website:
http://www.in.gov/fssa

Phone: 1-800-889-9949

 

Website:
www.ACCESSNebraska.ne.gov

Phone: 1-800-383-4278

 

 

IOWA – Medicaid

NEVADA – Medicaid

Website:
www.dhs.state.ia.us/hipp/

Phone: 1-888-346-9562

 

Medicaid Website:
http://dwss.nv.gov/

Medicaid Phone: 1-800-992-0900

 

 

KANSAS – Medicaid

Website:
http://www.kdheks.gov/hcf/

Phone: 1-800-792-4884

 

KENTUCKY – Medicaid

NEW HAMPSHIRE – Medicaid

Website:
http://chfs.ky.gov/dms/default.htm

Phone: 1-800-635-2570

 

Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf

Phone: 603-271-5218

LOUISIANA – Medicaid

NEW JERSEY – Medicaid and CHIP

Website:
http://www.lahipp.dhh.louisiana.gov

Phone: 1-888-695-2447

 

Medicaid Website: http://www.state.nj.us/humanservices/
dmahs/clients/medicaid/

Medicaid Phone: 1-800-356-1561

CHIP Website:
http://www.njfamilycare.org/index.html

CHIP Phone: 1-800-701-0710

 

 

MAINE – Medicaid

Website:
http://www.maine.gov/dhhs/ofi/public-assistance/index.html

Phone: 1-800-977-6740

TTY 1-800-977-6741

 

MASSACHUSETTS – Medicaid and CHIP

NEW YORK – Medicaid

Website:
http://www.mass.gov/MassHealth

Phone: 1-800-462-1120

 

 

Website: http://www.nyhealth.gov/health_care/medicaid/

Phone: 1-800-541-2831

 

MINNESOTA – Medicaid

NORTH CAROLINA – Medicaid

Website:
http://www.dhs.state.mn.us/

Click on Health Care, then Medical Assistance

Phone: 1-800-657-3629

 

 

Website:
http://www.ncdhhs.gov/dma

Phone: 919-855-4100

MISSOURI – Medicaid

NORTH DAKOTA – Medicaid

Website:
http://www.dss.mo.gov/mhd/participants
/pages/hipp.htm

Phone: 573-751-2005

 

 

Website:
http://www.nd.gov/dhs/services/
medicalserv/medicaid/

Phone: 1-800-755-2604

 

OKLAHOMA – Medicaid and CHIP

UTAH – Medicaid and CHIP

Website:
http://www.insureoklahoma.org

Phone: 1-888-365-3742

 

Website:
http://health.utah.gov/upp

Phone: 1-866-435-7414

 

OREGON – Medicaid and CHIP

VERMONT– Medicaid

Website:
http://www.oregonhealthykids.gov

http://www.hijossaludablesoregon.gov

Phone: 1-877-314-5678

Website:
http://www.greenmountaincare.org/

Phone: 1-800-250-8427

 

PENNSYLVANIA – Medicaid

VIRGINIA – Medicaid and CHIP

Website:
http://www.dpw.state.pa.us/hipp

Phone: 1-800-692-7462

 

Medicaid Website:
http://www.dmas.virginia.gov/rcp-HIPP.htm

Medicaid Phone: 1-800-432-5924

CHIP Website:
http://www.famis.org/

CHIP Phone: 1-866-873-2647

 

RHODE ISLAND – Medicaid

WASHINGTON – Medicaid

Website:
www.ohhs.ri.gov

Phone: 401-462-5300

 

Website: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm

Phone: 1-800-562-3022 ext. 15473

SOUTH CAROLINA – Medicaid

WEST VIRGINIA – Medicaid

Website:
http://www.scdhhs.gov

Phone: 1-888-549-0820

 

Website:
www.dhhr.wv.gov/bms/

Phone: 1-877-598-5820, HMS Third Party Liability

 

SOUTH DAKOTA - Medicaid

WISCONSIN – Medicaid

Website:
http://dss.sd.gov

Phone: 1-888-828-0059

               

Website:
http://www.badgercareplus.org/pubs/p-10095.htm

Phone: 1-800-362-3002

 

TEXAS – Medicaid

WYOMING – Medicaid

Website:
http://www.gethipptexas.com/

Phone: 1-800-440-0493

Website: http://health.wyo.gov/healthcarefin/equalitycare

Phone: 307-777-7531

 


To see if any more States have added a premium assistance program since November 3, 2010, or for more information on special enrollment rights, you can contact either:

U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)

OMB Control Number 1210-0137 (expires 09/30/2013)

U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Ext. 61565

Notice of TeamstersCare's Privacy Practices with Regard to Protected Health Information

This notice describes how medical information about you may be used and disclosed and what rights you have with regard to this information. Please review this notice carefully.

TeamstersCare is required by law to maintain the privacy of your protected health information (PHI) and to provide you notice of TeamstersCare's legal duties and privacy practices with respect to this health information. PHI is information which:

  • identifies you, and
  • relates to your past, present or future physical or mental health or condition, the provision of health care to you, or the payment for that care.

If you have questions about any part of this Notice, or if you want more information about our privacy practices, please contact the TeamstersCare Privacy Official at 16 Sever Street, Charlestown, MA 02129, or you may call 617-241-9220.

How TeamstersCare May Use or Disclose Your Protected Health Information

The following categories describe the ways that TeamstersCare may use and disclose your protected health information. We have not listed every use or disclosure that might be included in a given category. However, all the ways we are permitted to use and disclose information fall within one of these categories.

1. Treatment. Information obtained by a TeamstersCare provider, for example a dentist or pharmacist, may be disclosed to other healthcare providers who are part of your healthcare team in order to provide you with the best course of treatment.

2. Payment. We may use or disclose PHI about you to determine eligibility for plan benefits, obtain premiums, facilitate payment for the treatment and services you receive from health care providers, determine plan responsibility for benefits, and to coordinate benefits. For example, the "payment" category may include determining whether TeamstersCare covers a particular treatment.

3. Health Care Operations. We may use and disclose PHI about you to carry out necessary insurance-related activities. Such activities could include underwriting, premium rating and other activities relating to plan coverage; conducting or arranging for medical review, legal services, and audit services; and business planning, management, and general administration.

4. Required by Law. We will disclose your PHI when required to do so by federal, state or local laws. For example, we may disclose your PHI to the U.S. Department of Health and Human Services upon their request if they wish to determine whether we are in compliance with federal privacy laws.

5. Public Health. As required by law, we may disclose your PHI to public health authorities for purposes related to: preventing or controlling disease, injury, or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

6. Health Oversight Activities. We may disclose your PHI to health agencies, as authorized by law, during the course of audits, investigations, inspections, licensure, and other proceedings related to oversight of the health care system.

7. Judicial and Administrative Proceedings. We may disclose your PHI in the course of a judicial or administrative proceeding, such as a lawsuit, in response to a subpoena.

8. Law Enforcement. As required by law, we may disclose your PHI to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, or missing person; complying with a valid court order or subpoena; and for other law enforcement purposes.

9. Coroners, Medical Examiners and Funeral Directors. We may disclose your PHI to coroners, medical examiners, and funeral directors. For example, this may be needed in order to identify a deceased person or determine the cause of death.

10. Organ and Tissue Donation. Consistent with applicable law, we may disclose your PHI to organizations involved in procuring, banking, or transplanting organs and tissues.

11. Public Safety. We may disclose your PHI to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

12. National Security. We may disclose your PHI to authorized federal officials for military intelligence and national security purposes as authorized by law.

13. Correctional Institutions. We may disclose your PHI to a correctional institution, if you are an inmate, as necessary for your health.

14. Workers' Compensation. We may disclose your PHI as necessary to comply with workers' compensation or similar laws.

15. Marketing. We may contact you to give you information about health-related benefits and services that might interest you.

16. Disclosures to Trustees. If you appeal a claim to the TeamstersCare Board of Trustees, we may disclose limited PHI necessary for purpose of administering plan benefits.

When TeamstersCare May Not Use or Disclose Your Protected Health Information

Except as described in this Notice of Privacy Practices, we will not use or disclose your protected health information without written authorization from you. If you do authorize us to use or disclose your PHI for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer be able to use or disclose PHI about you for the reasons covered by your written authorization, though we will be unable to take back any disclosures we have already made with your permission.

Statement of Your Health Information Rights

1. Right to Inspect and Copy. You have the right to inspect and copy PHI about you in TeamstersCare records that may be used to make decisions about your plan benefits. To inspect or copy such information, you must submit your request in writing to the TeamstersCare Privacy Official, 16 Sever Street, Charlestown, MA 02129. If you request a copy of the information, we may charge you a reasonable fee to cover expenses associated with your request. We may deny your request to inspect or copy in certain limited circumstances. In such cases we will provide you with an explanation for the denial.

2. Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your PHI. TeamstersCare may not be able to comply with all requests. If you would like to make a request for restrictions, you must submit your request in writing to the TeamstersCare Privacy Official, 16 Sever Street, Charlestown, MA 02129.

3. Right to Request Confidential Communications. You have the right to receive your PHI through a reasonable alternative means or at an alternative location. To request confidential communications, you must submit your request in writing to the TeamstersCare Privacy Official, 16 Sever Street, Charlestown, MA 02129. TeamstersCare may not be able to comply with all requests.

4. Right to Request Amendment. You have the right to request that TeamstersCare amend your PHI when you believe the information is incorrect or incomplete. We are not required to change your PHI and if your request is denied, we will provide you with information about our denial and how you can appeal the denial. To request an amendment, you must make your request in writing to the TeamstersCare Privacy Official, 16 Sever Street, Charlestown, MA 02129. You must also provide a reason for your request.

5. Right to Accounting of Disclosures. You have the right to receive a list or "accounting of disclosures" of your PHI made by us, except that we do not have to account for disclosures made for purposes of treatment, payment or health care operations, disclosures made to you or others involved in your care, or disclosures that you authorize. To request this accounting of disclosures, you must submit your request in writing to the TeamstersCare Privacy Official, 16 Sever Street, Charlestown, MA 02129. Your request should specify a time period of up to six years and may not include dates before April 14, 2003. Upon your request, TeamstersCare will provide you with one list per 12-month period free of charge. We may charge you for additional lists.

6. Right to Paper Copy. You have the right to receive a paper copy of this Notice of TeamstersCare Privacy Practices at any time. To obtain a paper copy of this Notice, send your written request to the TeamstersCare Privacy Official, 16 Sever Street, Charlestown, MA 02129. You may also obtain a copy of this Notice at our website, www.TeamstersCare.com.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact the TeamstersCare Privacy Official, at 16 Sever Street, Charlestown, MA 02129 or you may call 617-241-9220.

Changes to this Notice of Privacy Practices

TeamstersCare reserves the right to amend this Notice of Privacy Practices at any time in the future and to make the new Notice provisions effective for all protected health information that it maintains. We will promptly revise our Notice and distribute it to you whenever we make material changes to the Notice. Until such time, TeamstersCare is required by law to comply with the current version of this Notice.

For More Information or to Report a Problem

If you have questions about this Notice of Privacy Practices, or about how we handle your PHI, you may contact the TeamstersCare Privacy Official, 16 Sever Street, Charlestown, MA 02129. If you believe your privacy rights have been violated, you can file a complaint with the TeamstersCare Privacy Official. All complaints to TeamstersCare must be submitted in writing. TeamstersCare will not retaliate against you in any way for filing a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W., Washington D.C. 20201. The secretary may be reached by phone at 202-690-7000.

Effective Date of This Notice: April 14, 2003

 

 

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