Required Notices

FCPS provides you with a summary of the following benefit plan benefit summaries. 

• Medical Summary Plan Description
• Vision Plan Summary
• Dental Buy Up Option
• Dental Standard Plan
• Flexible Spending Plan Summary
• Group Term Life Insurance Certificate

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

HIPAA Privacy Notice

Loss of Other Coverage

If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage or group health plan coverage, you may be able to enroll yourself and/or your dependents in this plan in the future, if you or your dependents lose eligibility for that other coverage or if the employer stops contributing towards your or your dependent’s coverage. To be eligible for this special enrollment opportunity, you must request enrollment within 31 calendar days after your other coverage ends or after the employer stops contributing towards the other coverage.

New Dependent as a Result of Marriage, Birth, Adoption or Placement for Adoption

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/or your dependent(s). To be eligible for this special enrollment opportunity, you must request enrollment within 31 calendar days after the marriage and within 31 days after the birth, adoption or placement for adoption.

Termination of Medicaid or SCHIP Coverage or Eligibility for Premium Assistance Under Medicaid or SCHIP

If you or your dependent is eligible, but not enrolled for coverage, you may be able to enroll yourself and/or your dependent if either of the following events occur:

• You or your dependent is covered under a Medicaid plan or under a State Child Health Insurance Plan (SCHIP) and coverage under the plan is terminated as a result of loss of eligibility; or 
• You or your dependent become eligible for premium assistance under Medicaid or SCHIP. To be eligible for this special enrollment opportunity, you must request enrollment within 60 calendar days after the date you or your dependent become eligible for premium assistance or you or your dependent’s Medicaid or SCHIP coverage ends.

The Genetic Information Nondiscrimination Act became effective January 1, 2010. The act prohibits health coverage discrimination and employment discrimination against employees based on their (or their family members’) genetic information.

Genetic Information Includes:

• Genetic tests;
• The request for, or receipt of, genetic counseling or other genetic services; and,
• The manifestation of a disease or disorder in an individual’s family member.

The availability of genetic testing and results of any genetic testing you undergo will be treated as confidential, as required by HIPAA and GINA. Likewise, genetic information collected about family history – such as through a Health Risk Assessment (HRA) – will be treated as confidential, as required by HIPAA and GINA.

Group 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’s or newborn’s attending provider, after consulting with the mother from discharging the mother or her newborn earlier than the 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization for the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

The Women’s Health and Cancer Rights Act requires group health plans that provide coverage for mastectomies to cover reconstructive surgery and prostheses following mastectomies. All medical plans provide this coverage.

If you receive benefits for a medically necessary mastectomy, and if you elect breast reconstruction after the mastectomy, you will also be covered for:

• 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 all stages of mastectomy including lymphedema.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. FCPS has determined that the prescription drug coverage offered by the FCPS Plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage.

Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.

You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. Beneficiaries leaving employer coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. If you do decide to enroll in a Medicare prescription drug plan and drop your FCPS prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan.

If you continue your coverage through the FCPS Retire healthcare Plan Option, you will have prescription coverage included in your FCPS health plan that meets creditable coverage.

You should also know that if you drop or lose your coverage with FCPS and do not enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. If you go 63 days or longer without prescription drug coverage that is at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you go 19 months without coverage, your premium will always be at least 19% higher than what many other people pay. You will have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to enroll.

For more information about th is notice or your current prescription drug coverage:

Contact your Medicare Division office for further information.

You will receive this notice annually and at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through FCPS changes. You may also request a copy.

For more information about your options under medicare prescription drug coverage:

More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans.

For more information about medicare prescription drug plans:

• Visit www.medicare.gov (opens in new window)
• Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help
• Call 1-800-MEDICARE (1-800-633-4227) TTY 1-877-486-2048.   For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov (opens in new window), or you can call them at 1-800-772-1213 (TTY 1-800-325-0778).

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).

https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/chipra/model-notice.pdf

The Affordable Care Act includes an individual shared responsibility provision that requires you, or your spouse, and your dependents to have qualifying health insurance coverage for the entire year.  In addition, it requires the employer to file with the Internal Revenue Service a list of their employees and dependents covered by health insurance during the year. FCPS will provide eligible employees with a 1095-C form to file with their Federal tax returns each year.

Health Care Reform Notice

Discrimination is Against the Law

FCPS complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Frederick County Public Schools does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Frederick County Public Schools

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

If you need these services, contact Donna Clabaugh, Senior Benefit Manager.

If you believe that Frederick County Public Schools 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 the Senior Benefit Manager:

Donna Clabaugh
Senior Benefit Manager
191 S. East Street
Frederick, MD 21701
(301) 644-5112
Fax: 301-644-5122

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Paula Lawton 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 (opens in new window), or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1–800–868–1019, 800–537–7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html (opens in new window).

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1-301-644-5112.

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-301-644-5112。

주의:  한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  1-301-644-5112 번으로 전화해 주십시오.

The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, is a federal that allows you to continue medical coverage if you or a dependent are no longer eligible due to employment status change or other life event.

In keeping with federal law, the FCPS COBRA plan gives each individual covered under a health or vision plan ability to continue the same coverage enrolled in before losing eligibility.  COBRA coverage is subject to all the same deductibles, exclusions, limitations, and other provisions as the terminated coverage.

Eligibility

You are eligible for COBRA coverage if you have lost your FCPS medical or dental plan coverage because of:

• Termination of employment
• Reduction in FTE (below .50) to ineligible status
• Death of spouse
• Divorce
• Change in child’s eligibility because of age (over 26), marriage, employment, or
• other disqualifying event

You are only able to elect to continue the same coverage you had prior to the status change.