Regulatory Benefit Notices

The university is required to provide you with important information regarding eligibility and enrollment, benefit coverage, COBRA rights, HIPAA privacy rules, and whether the university’s prescription drug coverage qualifies as creditable coverage for Medicare.  To view full regulatory benefit notices, refer to the links that follow each summary notice below. To request paper copies of the full benefit notices, contact the Benefits Office at 314-935-2332.

Continuation Coverage Rights Under COBRA

This general notice informs group health plan participants of their right under federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), to COBRA continuation coverage – a temporary extension of group health plan coverage.  COBRA continuation coverage is available to group health plan participants when they would otherwise lose their group health plan coverage.

Health Insurance Marketplace Notice

The Patient Protection and Affordable Care Act (PPACA) requires most individuals to have health insurance coverage or otherwise pay a tax penalty.  The goal is to ensure that individuals have access to affordable health insurance – whether through their own employer, a family member’s employer, an insurance company, or the government.  The Health Insurance Marketplace was established by the federal government in connection with the PPACA.  You can access information about the Health Insurance Marketplace and the PPACA’s requirements for individuals and families at Healthcare.gov or 1-800-318-2596.

HIPAA Privacy Notice

Washington University respects the confidentiality of your health information and recognizes that information about your health is personal.  WUSTL’s Comprehensive Employee Welfare Benefit Plan, which encompasses its group health plans and health spending plans, Employee Assistance Program and Wellness Program, is required by law to protect your health information and to inform you of its legal duties and your rights regarding such information.  This notice explains how, when and why these plans typically use and disclose your health information and your privacy rights regarding such information.

HIPAA Special Enrollment Rights

In accordance with the requirements of the Health Insurance Portability and Accountability Act (“HIPAA”), you have the right to enroll in a WUSTL group health plan under a “special enrollment” provision if you acquire a new dependent or if you decline coverage under WUSTL’s group health plans for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons.

Newborns’ & Mothers’ Health Protection Act of 1996

Group health plans generally may not 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 the group health plan may pay for a shorter stay if the attending provider, after consultation with the mother, discharges the mother or newborn earlier.   The group health plan may not require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours for a cesarean section).

Notice of Creditable Coverage

This notice, which applies to individuals who are entitled to Medicare benefits, provides information about the prescription drug coverage included with WUSTL’s health care benefits and the options that are available under Medicare’s prescription drug coverage.  This information is provided to assist such individuals in deciding whether or not to enroll in a Medicare prescription drug plan.

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

If you or your children are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) and you are eligible for WUSTL health insurance coverage, some states (including the State of Missouri) have premium assistance programs that can help pay for coverage, using funds from their Medicaid or CHIP programs.

Women’s Health and Cancer Rights Act of 1998

As required by the Women’s Health and Cancer Rights Act of 1998, WUSTL’s group health plans provide benefits for mastectomy, including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymphedema).

If you receive benefits under your health plan in connection with a mastectomy, benefits are also provided for the following services, as you determine appropriate with your attending physician:

  • All states 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.

The amount you must pay for such services are the same as are required for any other covered health services under your health plan.

Summary of Benefits and Coverage (SBC)

A standard Summary of Benefits and Coverage (SBC) is available for each of the five health plans offered by WashU. Each SBC provides a uniform description of covered benefits, cost sharing provisions, coverage limitations and coverage examples that illustrate the cost of care for certain medical conditions.

Illinois Essential Health Benefits (EHB) Disclosure

As required under Illinois state law, this notice provides information on what the WashU health plan covers versus the items and services within the 10 categories of EHBs that Illinois requires health insurance issuers to include in individual health insurance policies sold in Illinois.