Central PA Teamsters
September , 2013

New Health Insurance Marketplace Coverage Options and Your Health Coverage:



December, 2012

 AFFORDABLE CARE ACT CHANGES EFFECTIVE JANUARY 1, 2013:


Affordable Care Act Expands Preventive Coverage for Women’s Health

The Affordable Care Act-the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010-requires health plans to cover recommended preventive services with no cost sharing.

All plans under the Central Pennsylvania Teamsters Health and Welfare Fund will provide coverage for the services listed below, as developed by the Institute of Medicine and supported by the US Department of Health and Human Services, without cost sharing, effective January 1, 2013:

Type of Preventive Service

HHS Guideline for Health Insurance Coverage

Frequency

Well-woman visits.

Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. This well-woman visit should, where appropriate,  include other preventive services listed in this set of guidelines, as well as others referenced in section 2713.

Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors.

Screening for gestational diabetes.

Screening for gestational diabetes.

In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.  

Human papillomavirus testing.

High-risk human papillomavirus DNA testing in women with normal cytology results.

Screening should begin at 30 years of age and should occur no more frequently than every 3 years.

Counseling for sexually transmitted infections.

Counseling on sexually transmitted infections for all sexually active women.

Annual.

Counseling and screening for human immune-deficiency virus.

Counseling and screening for human immune-deficiency virus infection for all sexually active women.

Annual.

Contraceptive methods and counseling.

All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.

As prescribed.

Breastfeeding support, supplies, and counseling.

Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting and purchasing breastfeeding equipment.

In conjunction with each birth.

Screening and counseling for interpersonal and domestic violence.

Screening and counseling for interpersonal and domestic violence.

Annual.

 



November, 2011

 AFFORDABLE CARE ACT CHANGES EFFECTIVE JANUARY 1, 2012:

 

1.    Enrolling Adult Children Up to Age 26.  You may enroll your eligible dependent child up to age 26, even if that child has coverage available through his or her employer;

 

2.    Pre-Existing Condition Exclusions.  No pre-existing condition exclusions will be applied to you or to any of your eligible dependents;

 

3.    Preventive Care Services including Immunizations.  The PPACA requires coverage of specified preventive services and prohibits cost-sharing for those services.  The preventive services included in this mandate are only those “A” or “B” recommendations of the United States Preventive Services Task Force, Advisory Committee on Immunization Practices of the CDC and the Health Resources and Services Administration.  To review the list of "A" or "B" recommendations, click on the link below These services are recommended only for patients with certain risk factors (including age, high blood pressure, etc.).  These recommended services will be covered at 100%, with no deductible, copayment, or other cost-sharing requirement.  In addition to preventive services, some non-prescription medications are included in the recommendations.  However, you will have to obtain a prescription for these otherwise non-prescription medications in order to receive the medication with no copayment.

 

NOTE:  Although the recommended preventive care services will be provided at no cost, you may be charged an office visit copayment or copayments for other services if non-preventive services are rendered at the same time.

 

4.    Internal Review and Appeal of Claims.  You will have additional rights regarding challenging or appealing any Adverse Benefit Determination.  For example, if the Fund relies on newly received information in reviewing your claim for benefits, the Fund will provide you with a copy so that you can address any such additional information.  If you would like to request a review or appeal of your claim, please call Lou Ann DeLong, Benefits Manager, at 610-320-9244, and you will be provided with all of the information you need to initiate the review or appeal.  In the coming months, you will receive a Summary Plan Description that provides detailed information about these procedures and what you must do to seek an internal review and appeal of your claims.

 

5.    External Review of Claims.  In addition to appealing the denial of a claim for benefits through the Fund’s internal review and appeal process, in certain cases, you will also have the right to request an external review by an independent review organization.  The Fund will provide for this external review in compliance with all applicable federal guidance.  If you would like to request an external review after you have exhausted the internal review and appeal procedures OR if your claim is an “urgent” claim and you would like to request concurrent internal and external reviews, please call Lou Ann DeLong, Benefits Manager, at 610-320-9244.  In the coming months, you will receive a Summary Plan Description that provides detailed information about these procedures and what you must do to seek an external review of your claims.



Links:

USPSTF "A" and "B" Recommendations

Application Form

Medicare Questionnaire

Notice About the Early Retiree Reinsurance Program

Central Pennsylvania Teamsters Pension Fund
P.O. Box 15223
Reading, PA 19612-5223
Toll Free in PA:
1-800-343-0136
Toll Free in USA:
1-800-331-0420

 

Central Pennsylvania Teamsters Health & Welfare Fund
P.O. Box 15224
Reading, PA 19612-5224
Toll Free in PA:
1-800-422-8330
Toll Free in USA:
1-800-331-0420

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