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Federal Notices

Important Notice from Beaverton School District 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 Kaiser or with either one of the Regence Blue Cross Plans 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 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. 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. Beaverton School District has determined that the prescription drug coverage offered

by Kaiser and both of the Regence Blue Cross plans are, 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 two (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?

If you decide to join a Medicare drug plan, your current Kaiser and Blue Cross coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current Kaiser or Blue Cross coverage, be aware that you and your dependents will be able to get this coverage back during an 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 Kaiser or Blue Cross 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 nineteen 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 November 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 Kaiser or Blue Cross 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:

Visit www.medicare.gov

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

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Date: October 18, 2018

Name of Entity/Sender: Beaverton School District

Contact: Debbie Johnson, Health Resource Coordinator

Address: 16550 SW Merlo Rd., Beaverton, OR 97003

Phone Number: 503-356-4459

Children's Health Insurance Program - CHIPs

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

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).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2018. Contact your State for more information on eligibility –

ALABAMA – Medicaid	FLORIDA – Medicaid
Website: http://myalhipp.com/ Phone: 1-855-692-5447	Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268
ALASKA – Medicaid	GEORGIA – Medicaid
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.asp x	Website: http://dch.georgia.gov/medicaid - Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507
ARKANSAS – Medicaid	INDIANA – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)	Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone 1-800-403-0864
COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)	IOWA – Medicaid
Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711	Website: http://dhs.iowa.gov/ime/members/medicaid-a-to- z/hipp Phone: 1-888-346-9562

KANSAS – Medicaid	NEW HAMPSHIRE – Medicaid
Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512	Website: https://www.dhhs.nh.gov/ombp/nhhpp/ Phone: 603-271-5218 Hotline: NH Medicaid Service Center at 1-888-901- 4999
KENTUCKY – Medicaid	NEW JERSEY – Medicaid and CHIP
Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570	Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
LOUISIANA – Medicaid	NEW YORK – Medicaid
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447	Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
MAINE – Medicaid	NORTH CAROLINA – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public- assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711	Website: https://dma.ncdhhs.gov/ Phone: 919-855-4100
MASSACHUSETTS – Medicaid and CHIP	NORTH DAKOTA – Medicaid
Website: http://www.mass.gov/eohhs/gov/departments/masshe alth/ Phone: 1-800-862-4840	Website: http://www.nd.gov/dhs/services/medicalserv/medicaid / Phone: 1-844-854-4825
MINNESOTA – Medicaid	OKLAHOMA – Medicaid and CHIP
Website: http://mn.gov/dhs/people-we- serve/seniors/health-care/health-care- programs/programs-and-services/medical- assistance.jsp Phone: 1-800-657-3739	Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
MISSOURI – Medicaid	OREGON – Medicaid
Website: https://www.dss.mo.gov/mhd/participants/pages/hipp. htm Phone: 573-751-2005	Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075
MONTANA – Medicaid	PENNSYLVANIA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HI PP Phone: 1-800-694-3084	Website: http://www.dhs.pa.gov/provider/medicalassistance/he althinsurancepremiumpaymenthippprogram/index.ht m Phone: 1-800-692-7462
NEBRASKA – Medicaid	RHODE ISLAND – Medicaid
Website: http://www.ACCESSNebraska.ne.gov Phone: (855) 632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178	Website: http://www.eohhs.ri.gov/ Phone: 855-697-4347
NEVADA – Medicaid	SOUTH CAROLINA – Medicaid
Medicaid Website: https://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900	Website: https://www.scdhhs.gov Phone: 1-888-549-0820

SOUTH DAKOTA - Medicaid	WASHINGTON – Medicaid
Website: http://dss.sd.gov Phone: 1-888-828-0059	Website: http://www.hca.wa.gov/free-or-low-cost- health-care/program-administration/premium-payment- program Phone: 1-800-562-3022 ext. 15473
TEXAS – Medicaid	WEST VIRGINIA – Medicaid
Website: http://gethipptexas.com/ Phone: 1-800-440-0493	Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
UTAH – Medicaid and CHIP	WISCONSIN – Medicaid and CHIP
Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669	Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.p df Phone: 1-800-362-3002
VERMONT– Medicaid	WYOMING – Medicaid
Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427	Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531
VIRGINIA – Medicaid and CHIP
Medicaid Website: http://www.coverva.org/programs_premium_assistance. cfm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance. cfm CHIP Phone: 1-855-242-8282

To see if any other states have added a premium assistance program since January 31, 2018, or for more information on special enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/agencies/ebsa www.cms.hhs.gov

1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2019)

Early Retiree Reinsurance Program - ERRP

REQUIRED FEDERAL NOTICE—PLEASE READ

No action is required of you at this time. Please read this notice carefully and keep it where you can find it. You are responsible for sharing this notice to current and future family members that are enrolled in your Beaverton School District medical plans.

You are receiving the Early Retiree Reinsurance Program (ERRP) notice as a requirement under federal law. The money received under the federal program described in this notice will be used to offset future rate increases from our health plans until the program expires. This notice does not impact your eligibility for coverage under the Beaverton School District medical plans.

NOTICE ABOUT THE EARLY RETIREE REINSURANCE PROGRAM

You are a plan participant, or are being offered the opportunity to enroll as a plan participant, in an employment-based health plan that is certified for participation in the Early Retiree Reinsurance Program. The Early Retiree Reinsurance Program is a Federal program that was established under the Affordable Care Act. Under the Early Retiree Reinsurance Program, the Federal government reimburses a plan sponsor of an employment-based health plan for some of the costs of health care benefits paid on behalf of, or by, early retirees and certain family members of early retirees participating in the employment-based plan. By law, the program expires on January 1, 2014.

Under the Early Retiree Reinsurance Program, your plan sponsor may choose to use any reimbursements it receives from this program to reduce or offset increases in plan participants’ premium contributions, co-payments, deductibles, co-insurance, or other out-of-pocket costs. If the plan sponsor chooses to use the Early Retiree Reinsurance Program reimbursements in this way, you, as a plan participant, may experience changes that may be advantageous to you, in your health plan coverage terms and conditions, for so long as the reimbursements under this program are available and this plan sponsor chooses to use the reimbursements for this purpose. A plan sponsor may also use the Early Retiree Reinsurance Program reimbursements to reduce or offset increases in its own costs for maintaining your health benefits coverage, which may increase the likelihood that it will continue to offer health benefits coverage to its retirees and employees and their families.

If you have received this notice by email, you are responsible for providing a copy of this notice to your family members who are participants in this plan.

District Goal for 2010-15: All students will show continuous progress toward their personal learning goals, developed in collaboration with teachers and parents, and will be prepared for post-secondary education and career success.

The Beaverton School District recognizes the diversity and worth of all individuals and groups. It is the policy of the Beaverton School District that there will be no discrimination or harassment of individuals or groups based on race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, marital status, age, veterans' status, genetic information or disability in any educational programs, activities or employment.

HIPPA Special Enrollment Rights Notice

Special Enrollment Rights Notice

Under the special enrollment provisions of HIPAA, you may be eligible, in certain situations, to enroll in a Beaverton School District medical plan during the year, even if you previously declined coverage. This right extends to you and all eligible family members.

** You will be eligible to enroll yourself (and eligible dependents) if, during the year you or your dependents have lost coverage under another plan because:

*Coverage ended due to termination of employment, divorce, death, or a reduction in hours that affected benefits eligibility;

*Employer contributions to the plan stopped;

*The plan was terminated;

*COBRA coverage ended; or

*The lifetime maximum for medical benefits was exceeded under the existing medical coverage option.

You must notify the plan within 30 days of the loss of coverage in order to enroll on the Beaverton School District medical plan during the year.

Otherwise, you will need to wait until the plans open enrollment period.

**If you gain a new dependent during the year as a result of marriage, birth, adoption or placement for adoption, you may enroll that dependent , as well as yourself and any other eligible dependents , in the plan again, even if you previously declined medical coverage.

You must notify the plan within 30 days of the event in order to enroll on the Beaverton School District medical plan during the year. Otherwise, you will need to wait until the plans open enrollment period. Coverage will be retroactive to the date of the birth or adoption for children enrolled during the year under these provisions.

**Effective April 1, 2009, you will be eligible to enroll yourself and eligible dependents

if either of two events occur:

*You or your dependent loses Medicaid or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible.

*You or your dependent qualifies for state assistance in paying your employer group medical plan premiums.

Regardless of other enrollment deadlines , you will have 60 days from the date of the Medicaid/CHIP event to request enrollment in the Beaverton School District medical plan.

Please note that special enrollment rights allow you to either:

*Enroll in your current medical coverage; or

*Enroll in any medical plan benefit option for which you and your dependents are eligible.

Lifetime LImits and Women's Health Cancer Rights Act

REQUIRED FEDERAL NOTICES-PLEASE READ

Lifetime Limit No Longer Applies

The lifetime limit on the dollar value of benefits under the Beaverton School District Regence group medical plans no longer applies.

For more information, contact the District's Health Resource Coordinator, Debbie Johnson, RN, at (503) 356-4459 or debbie johnson-HR @bcaverton.k12.or.us

Women' s Health and Cancer Rights Act of 1998 (WHCRA)

WHCRA includes important protections for breast cancer patients who choose to have breast reconstruction in connection with a mastectomy.

The coverage outlines below is included in your Regence and Kaiser medical plan:

Reconstruction of the breast on which the mastectomy was performed
Surgery and reconstruction of the other breast to produce a symmetrical appearance
Prosthesis and treatment of physical complications of all stages of mastectomy,including lymphademas

The attending physician and the patient will determine the manner of treatment.

All coverage is subject to any deductibles, copayments, and/or coinsurance according to the provisions of your health insurance benefits and federal requirem ents. Please see your benefits booklet for additional information.

Newborn's and Mother's Health Protection Act Notice

Newborn's and Mothers' Health Protection Act Notice

Maternity Benefits

Under Federal and state law you have certain rights and protections

regarding your maternity benefits under the Plan.

Under federal law known as the "Newborns' and Mothers' Health Protection Act of 1996" (Newborns' Act) group health plans and health insurance issuers 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, 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 the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Women's Preventive Health Care

Under the Affordable Care Act passed in 2010, Regence currently covers women's preventive health care services such as mammograms, screenings for cervical cancer and other services al no cos! share. On August 1, 2011, the Department of Health and Human Services (HHS) adopted additional guidelines for women's preventive services that will also be covered at 100% and not subject to deductible. These guidelines, detailed below, will apply lo your plan as it renews on or after

August 1, 2012.

Type of Preventive Service What is Covered
Contraceptive Methods and Counseling When a plan does not provide a Pharmacy benefit, contraceptive medications will be added to the existing Preventive only Rx plan.	The following medications and products are covered under Preventive Care: .• Generic contraceptive pills. Generic injectables and formulary brand patches. • Implants, cervical caps, and IUDs are covered under the Preventive Care Medical benefit. Diaphragms are covered under Preventive Care (Medical or Pharmacy). • Insertion of a device is covered under Preventive Care. Removal is covered at . regular plan benefits if a Family Planning benefit applies. Generic emergency contraception products. Contraceptive products require a prescription for coverage. Generic contraceptive medications are covered. Other medications or products used for contraception are covered under regular plan benefits (if pharmacy benefit-s apply). When no generic exists, a formulary brand is covered. If a generic becomes available, the formulary brand will no longer be covered under Preventive care. Members can get the most value for their health care dollars with preferred medications. Learn more at regencerx.com/learn/covered. Over-the-counter products are not covered.
	Sterilization is covered.
	Education and training on contraceptive methods are covered under Preventive Care.
Well-Woman Visits	Preventive care visits for adult women are covered under Preventive Care.
Breast-Feeding Support, Supplies and Counseling	Manual and electric breastfeeding pumps are covered under Preventive Care when purchased or rented from a licensed provider. Off-the-shelf pumps from a retail outlet are not covered. Hospital-grade pumps are not covered.
	The initial breastfeeding supplies provided with a breastfeeding pump are covered under Preventive Care.
	Lactation support and counseling are covered under Preventive Care when provided by a licensed provider.
Screening for Gestational Diabetes	Screening is covered under Preventive Care for pregnant women between 24 and 28 weeks of gestation and the first prenatal visit for pregnant women at high risk for diabetes.
HPV Testing	Screening is covered under Preventive Care for women from age 30, every 3 years.
Counseling for Sexually Transmitted Infections	Counseling during well-women visits on an annual basis for all sexually active women will be covered under Preventive Care.
Counseling and Screening for HIV	Screening and counseling during well-women visits for all sexually active women will be covered under Preventive Care.
Counseling and Screening for Interpersonal and Domestic Violence	Screening and counseling during well-women visits will be covered.

You'll find more detailed information on other covered preventive services on our Preventive Care Brochure, including additional screenings, tests and counseling for adults, and child and adolescent immunizations. This brochure can be viewed online al http://www.regence.com/transparency/coverage-on-preventive-services.jsp.

Health insurers continue to receive information from the U.S. Department of Health and Human Services regarding the new law. Therefore, this information is subject to change. The information provided in this document should not be construed as legal advice.

Revised 9-13-12

Regence BlueCross BlueShield of Oregon is an independent licensee of the Blue Cross and Blue Shield Association