Trust Meeting Documents and Legal Notices

Meeting Agendas and Minutes

Legal Notices

ARTICLE I

NOTICE OF WOMEN’S HEALTH AND 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:

(1) All stages of reconstruction of the breast on which the mastectomy was performed;

(2) Surgery and reconstruction of the other breast to produce a symmetrical appearance;

(3) Prostheses; and

(4) Treatment of physical complications of the mastectomy, including lymphedema.

This coverage is subject to the same Deductibles and co-payments consistent with those established for other benefits under your plan.

ARTICLE III

NOTICE OF PRESCRIPTION DRUG COVERAGE AND MEDICARE

Important Notice About Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current Prescription Drug coverage with the Rural Arizona Group Health Trust (RAGHT) and about your options under Medicare’s Prescription Drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare Prescription Drug coverage in your area. Information about where you can get help to make decisions about your Prescription Drug coverage is at the end of this notice.

There are 2 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. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers Prescription Drug coverage. All Medicare 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) It has been determined that the Prescription Drug coverage offered by RAGHT is, on average for all plan participants, expected to pay out as much as standard Medicare Prescription Drug coverage pays and is therefore considered creditable coverage. Because your existing coverage is creditable coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. However, if you lose your current creditable Prescription Drug coverage, through no fault of your own, you will also be eligible for a 2 month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
Your current RAGHT medical coverage pays for other health expenses in addition to Prescription Drugs. If you and/or your Covered Dependents enroll in a Medicare drug plan, you and/or your Covered Dependents will still be eligible to receive medical and Prescription Drug benefits through RAGHT. If you and/or your Covered Dependents enroll in a Medicare drug plan, in general, the following guidelines listed below apply.

If you are an active Covered Employee, or the Covered Dependent of an active Covered Employee, you are required to obtain your Outpatient Prescription Drug benefits through your RAGHT plan first. You can then file on a secondary basis with your Medicare drug plan.

If you are a COBRA participant, or the Covered Dependent of a COBRA participant, you are required to obtain your Outpatient Prescription Drugs through your Medicare drug plan first. Secondary coverage is not available through RAGHT.

Important: You can only waive Prescription Drug coverage by waiving the entire RAGHT medical/prescription plan coverage for yourself and your Covered Dependents. Remember, if you do waive your RAGHT coverage, you can only re-enroll in the RAGHT medical plan coverage during the next Open Enrollment period.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with RAGHT and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable Prescription Drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare Prescription Drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice Or Your Current Prescription Drug Coverage…
Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through RAGHT changes. You also may request a copy of this notice at any time.

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 drug plans.

For more information about Medicare Prescription Drug coverage:
(1) Visit www.medicare.gov.

(2) Call your state Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.

(3) Call (800) 6334-2273 ((800) 633-4227). TTY users should call (877) 486-2048.

If you have limited income and resources, extra help paying for Medicare Prescription Drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at (800) 772-1213 (TTY (800) 325-0778).

Date: July 1, 2017

Name of Entity/Sender: Rural Arizona Group Health Trust

Address: 1115 Stockton Hill Road, Suite 101

Kingman, AZ 86401

Phone Number: (928) 391-2298

ARTICLE II

NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT

STATEMENT OF RIGHTS

Under federal law, group health plans and health insurance issuers offering group health insurance coverage 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 delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (e.g., the Member's Physician, nurse midwife, or Physician assistant), after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan or issuer may not, under federal law, 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). Precertification is still required for the delivery and for newborn placement in an intensive care nursery. Precertification is also required for any length of stay period in excess of the minimum (48 or 96 hours), even though not required for the minimum length of stay period.

ARTICLE V

HIPAA PRIVACY AND SECURITY NOTICE

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Effective Date of this Notice is September 23, 2013.

Your Rights

You have the right to:

  • Get a copy of your health and claims records
  • Correct your health and claims records
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we’ve shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

Your Choices
You have some choices in the way that we use and share information as we:

  • Answer coverage questions from your family and friends
  • Provide disaster relief
  • Market our services and sell your information

Our Uses and Disclosures
We may use and share your information as we:

  • Help manage the health care Treatment you receive
  • Run our organization
  • Pay for your health services
  • Administer your health plan
  • Help with public health and safety issues
  • Do research
  • Comply with the law
  • Respond to organ and tissue donation requests and work with a medical examiner or funeral director
  • Address workers’ compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions

Your Rights 

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of health and claims records

  • You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct health and claims records

  • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for Treatment, payment, or our operations.
  • We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for 6 years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about Treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information

Our Uses and Disclosures 

How do we typically use or share your health information?
We typically use or share your health information in the following ways.

Help manage the health care Treatment you receive
We can use your health information and share it with professionals who are treating you.
Example: A doctor sends us information about your diagnosis and Treatment plan so we can arrange additional services.

Run our organization

  • We can use and disclose your information to run our organization and contact you when necessary.
  • We are not allowed to use Genetic Information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.

Example: We use health information about you to develop better services for you.

Pay for your health services
We can use and disclose your health information as we pay for your health services.
Example: We share information about you with your dental plan to coordinate payment for your dental work.

Administer your plan
We may disclose your health information to your health plan sponsor for plan administration.
Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.

How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues
We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

Do research
We can use or share your information for health research.

Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

  • We can share health information about you with organ procurement organizations.
  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

  • We can use or share health information about you:
  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

 Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will provide a copy to you.

Additional information
After reading this Notice, if you have questions about the Plan’s health information HIPAA Administrative Simplification Policies and Procedures or if you need additional information, you should contact:

Rural Arizona Group Health Trust’s Privacy Officer:

1115 Stockton Hill Road, Suite 101

Kingman, AZ 86401

(P) (928) 391-2298

ARTICLE IV

MEDICAID (AHCCCS) AND THE CHILDREN’S HEALTH INSURANCE PROGRAM

(CHIP)

Medicaid (AHCCCS) And the Children’s Health Insurance Program (Chip) Offer Free or Low Cost Health Coverage to Children and Families

If you are eligible for health coverage from your Employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid (AHCCCS in Arizona) or CHIP programs to help people who are eligible for Employer-sponsored health coverage, but need assistance in paying their health premiums.

If you or your Covered Dependents are already enrolled in Medicaid (AHCCCS) or CHIP, you can contact the Arizona Medicaid (AHCCCS) or CHIP office to find out if premium assistance is available.

If you or your Covered Dependents are NOT currently enrolled in Medicaid (AHCCCS) or CHIP, and you think you or any of your Covered Dependents might be eligible for either of these programs you can contact:

ARIZONA – CHIP
Website: http://www.azahcccs.gov/applicants/default.aspx
Phone: (602) 417-5422
Or
Dial (877) 543-7669 or www.insurekidsnow.gov to find out how to apply

Once it is determined that you or your Covered Dependents are eligible for premium assistance under Medicaid (AHCCCS) or CHIP, your employer’s health plan is required to permit you and your Covered Dependents to enroll in the plan – as long as you and your Covered Dependents are eligible, but not already enrolled in the employer’s plan.

This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.

To research the availability of, and your eligibility for, premium assistance in other states, please contact the following agencies:

U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
(866) 444-3272

U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
(877) 267-2323, Ext. 61565