Glossary of Health Coverage and Medical Terms (click here)
SAR Summary Annual Report
A Grandfathered Plan under the Affordable Care
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
Notice about the Early Retiree Reinsurance
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
Under Medicaid and the Children’s Health Insurance
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
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:
Department of Labor
Employee Benefits Security Administration
OMB Control Number 1210-0137 (expires
Department of Health and Human Services
Centers for Medicare & Medicaid Services
1-877-267-2323, Ext. 61565
of TeamstersCare's Privacy Practices with Regard to Protected
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.
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
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.
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.
TeamstersCare May Use or Disclose Your Protected Health
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.
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.
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.
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.
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.
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.
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.
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.
and Tissue Donation. Consistent with applicable
law, we may disclose your PHI to organizations involved
in procuring, banking, or transplanting organs and
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.
National Security. We may disclose your PHI
to authorized federal officials for military intelligence
and national security purposes as authorized by law.
Institutions. We may disclose your PHI to a
correctional institution, if you are an inmate, as
necessary for your health.
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.
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.
TeamstersCare May Not Use or Disclose Your Protected
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
of Your Health Information Rights
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.
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.
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.
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.
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.
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.
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
to this Notice of Privacy Practices
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.
More Information or to Report a Problem
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.
Date of This Notice: April 14, 2003