17 CITY OF LAMAR LEGAL NOTICES PATIENT PROTECTIONS DISCLOSURE The City of Lamar Health Plan generally may require the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. Until you make this designation, Anthem designates one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Anthem at 866.698.0087 or www.anthem.com. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from Anthem or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a preapproved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the Anthem at 866.698.0087 or www.anthem.com. WOMEN’S HEALTH & CANCER RIGHTS ACT If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (“WHCRA”). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: • All stages 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. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan. Therefore, the following deductibles and coinsurance apply: Plan 1: PPO B2000 PLAN (Individual: 20% coinsurance and $2,000 deductible; Family: 20% coinsurance and $4,000 deductible) Plan 2: HDHP W/ HSA 2500 Plan (Individual: 20% coinsurance and $2,500 deductible; Family: 20% coinsurance and $5,000 deductible) If you would like more information on WHCRA benefits, please call your Plan Administrator at 719.336.1366 or Margaret.saldana@ci.lamar.co.us. NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT 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 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
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