More Required Notices
General Notice of COBRA Continuation Coverage Rights
Your eligibility for benefits (and that of your enrolled dependents) ceases at the end of the month in which your employment is terminated or if the benefits program is discontinued. Insurance coverage for dependents will also terminate at the end of the month in which your dependent is no longer eligible.
The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) gives employees and their qualified beneficiaries the opportunity to continue benefit coverage under the employer’s medical plans, dental plans, vision plan, and flexible spending accounts when a “qualifying event” would normally result in the loss of eligibility. Examples include termination of employment, death of the employee, reduction in work hours, divorce or loss of eligibility by a dependent child.
The plans available through COBRA continuation coverage are the same plans currently offered by the University; however, you or your dependent(s) must pay the full cost of the health, dental and vision plan, plus an administrative fee. COBRA premiums are due monthly, and failure to pay on time will result in loss of coverage.
Length of COBRA Continuation Coverage
Coverage may continue for differing lengths of time depending upon the reason for eligibility.
- Up to 18 months if loss of coverage is due to termination of employment or reduction in work hours
- Up to 36 months for dependents if loss of coverage is due to death, divorce, or a dependent child's loss of eligibility
- Up to 29 months if the individual is disabled at the time of eligibility for continued coverage or is disabled within 60 days of eligibility for continued coverage
To apply for COBRA coverage, contact the Benefits Office to complete a Qualified Life Event form when a divorce is final, a dependent child no longer meets age and/or dependency eligibility requirements as outlined in each specific plan, you get married or you have a baby.
Within 14 days, the Benefits Office will provide you and/or your qualified dependent pertinent information on the application procedure and eligibility for continuation of coverage through COBRA.
GINA is a federal mandate the affects group products for groups of all sizes, in addition to individual products and Medigap. Title I of GINA prohibits genetic discrimination in the health insurance markets and requires the Secretary of the Department of Health and Human Services revise the HIPAA Privacy Rule relative to the use of genetic information.
Title II of the Genetic Information Nondiscrimination Act of 2008 protects applicants and employees from discrimination based on genetic information in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. GINA also restricts employers’ acquisition of genetic information and strictly limits disclosure of genetic information. Genetic information includes information about genetic tests of applicants, employees, or their family members; the manifestation of diseases or disorders in family members (family medical history); and requests for or receipt of genetic services by applicants, employees, or their family members.
Notice of Health Information Practices
This notice describes how patient health information (PHI) about you may be used and disclosed and how you can get access to this health information. Please read it carefully and ask any questions.
What is Health Information:
Each time that a service is rendered or a procedure is done, even as simple as a routine blood pressure check, data and information are collected. This is health information or what is commonly referred to as information for or in the medical record or the patient record. Accurate, credible, and timely data and information are used by this organization, covered entity, as the basis for planning your care, as a means of having multiple healthcare providers know about your current health status, for health insurance, as a health legal document, as a record for billing purposes, as a source of data for research, planning, and marketing, as a source of required information for public health officials, and as a means to continue to improve the care that we provide. At this organization, we have always, and will continue to protect the privacy of your health information and the dignity of you as an individual. On July 6, 2001, the U.S. Federal Government passed compliance regulations that mandate all healthcare facilities, health plans, and clearinghouses to protect health information and inform consumers of the healthcare information practices of the facility. Overtime amendments and additions have been made and are incorporated into this Notice.
The Consumer's Health Information Rights
This facility maintains a medical record for you containing medical information concerning you. With this in mind, you have the right to:
-Request a restriction on use and disclosure of health information, although the facility is not required to comply except as follows. A covered entity must agree to the request of an individual to restrict disclosure of PHI about the individual to a health plan if the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law and the PHI pertains solely to a healthcare item or service for which the individual or another on behalf of the individual, other than the health plan, has paid the covered entity in full. A covered entity may terminate a restriction by informing the individual except for the above. (45CFR164.522)
- Obtain a copy of this notice
- Inspect, have access to, and receive a copy of your medical record (45CFR 164.524) A fee for labor and materials can be assessed.
- Amend your medical record (45 CFR 164.528)
- Obtain an accounting of disclosures of your medical record (45 CFR 164.528)
- Request your medical record by alternative means or location. You are entitled to receive electronic copies of PHI only if that PHI is already maintained in electronic format. The method of electronic transmission, the sending and receiving, must be deemed secure.
- Revoke your authorization to use or disclose your health information except to the extent that action has already been taken
This Organization's Responsibilities:
This organization's mission of quality service and respect of the individual has always taken into account protecting health information privacy. Our responsibilities are to:
- Maintain the privacy of your health information
- Provide you this notice of health information practices
- Notify you if we are unable to satisfy a request or a restriction.
- Accommodate all reasonable requests while maintaining quality care and respect for you
- Make you aware of all health information practice policy changes
- We will not use or disclose your PHI your approval except as stated in this notice.
- When PHI is disclosed as above, it will be disclosed at the minimum necessary level.
- Account for how patient data are being used.
- Notify affected individuals following a breach of unsecured protected health information
To Request Further Information or ask Questions:
If you would like further information or have questions, this organization employs a HIPAA Compliance Officer who can be reached at (412) 396-1387.
If you believe that your privacy rights have been violated, you can file a complaint
with the Compliance Officer or with the Secretary of Health and Human Services. There
will be no penalty or retaliation for filing a complaint.
Examples of Permitted Types of Uses and Disclosures of Health Information:
This organization may use or be required to use your health information without your authorization or consent for normal business activities as follows:
For Care and Treatment: Health information obtained by a healthcare practitioner such as a physician, nurse, or therapist, will be entered into your medical record and used to determine a plan of care. For example, healthcare members will write and read what others have written such that your care can be coordinated and everyone is aware of how you are responding to your treatment plan. In addition, your health information may go with you such that future healthcare providers will have a record of your care. Your health insurer may disclose health information to the sponsor of the plan.
For Billing and Payment: In addition to demographic information, information on a bill sent to an insurer may include health information. This health information is restricted to that which is needed for the financial transactions.
For Healthcare Operations: In order to provide quality care and for payment, this organization may use your health information, for example, to analyze the care, treatment, and outcomes of your medical case and of others. This health information will be used to continually improve the care of the services that are provided. If a health plan receives protected health information for the purpose of underwriting, premium rating, or other activities relating to the creation, renewal, or replacement of a contract of health insurance or health benefits, and if such health insurance or health benefits are not placed with the health plan, such health plan may only use or plan, such health plan may only use or disclose such protected health information for such purposes or as may be required by law, subject to the prohibition at 164.502 (a)(5)(i) with respect to the genetic information included in the protected health information.
In accordance with 164.504(f) , the group health plan, or a health insurance issuer or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan with the exception of genetic information as above.
For Directory Purposes: Where applicable, we will use your name, location, general medical condition, and religious affiliation for directory purposes unless you instruct us not to. This health information is only for the use of clergy and to people who ask for you specifically by full name (although religious affiliation will not be given to the latter).
For Business Associates: In order to provide quality services, this organization requires business services such as pharmacy, health insurance, clinic services, information technology, vendors, etc.. These services will have use of your health information at the minimum necessary level as it pertains to their service delivery. Also, business associates and their subcontractors must follow Federal standards for protecting your health information and sign a business associate agreement. In addition, the business associates must follow the HIPAA Privacy Rule, the Security Rule as specified in the Health Information Technology for Economic and Clinical Health Act (HITECH)/Energy and Commerce Recovery and Reinvestment Act, Subtitle D, Section 4401,and 45CFR164.502(a)(5)(ii)(A).
For Clergy: Where applicable, unless you specify that you object, health information such as your name and general medical condition will be given to clergy for professional purposes only.
For Notification: We may use or disclose health information, such as your general condition, to notify or assist in notifying a family member or person responsible for your care.
For Communication: We may use or disclose health information relevant to your care to family member's or those that you deem responsible for your care on a need to know basis.
For Research: We may disclose health information to researchers if they have appropriate consent forms and the research has been approved by our institutional review board. The researchers will be held to this facility's health information privacy standards.
For Funeral Directors: We may disclose health information to funeral directors in accordance with state laws and for professional purposes only.
For Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or organizations involved in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
For Marketing Purposes: Where applicable, we may contact you to provide information on appointment reminders or alternative treatments and services that may benefit you given your medical condition. In addition, a covered entity or business associate shall not directly or indirectly receive remuneration in exchange for any protected health information of an individual unless the covered entity obtained from the individual, in accordance with section 164.508 of title 45, Code of Federal Regulations, a valid authorization that includes a specification of whether the protected health information can be further exchanged for remuneration by the entity receiving protected health information of that individual. Exceptions under HITECH include, when the purpose of the exchange is for research, public health, treatment, health care operations, providing an individual with a copy of their protected health information, and for remuneration that is provided by a covered entity to a business associate for activities involving the exchange of protected health information that the business associate undertakes on behalf of and at the specific request of the covered entity pursuant to a business associate agreement. The price charged must reflect not more than the costs of preparation and transmittal of the data for such purpose.
For Fundraising: We may contact you for fundraising efforts conducted for this organization's benefit. Per 45CFR164.514(f)(1)(i-vi), the PHI used without an authorization is limited. You also have the right to opt out of receiving any further fundraising communication, and to opt back in.
For the Food and Drug Administration: As requested or required by the FDA, we may disclose health information relative to an adverse health condition related to food, food supplements, product and product defects related to food, or post marketing surveillance information to allow product recalls, repairs, or replacements.
For Workers Compensation Issues: In compliance with Worker's Compensation laws, health information may be revealed to the extent necessary to comply with the law and your individual case.
For Public Health Requirements: As required by law, health information may be disclosed to public health or legal authorities for the jurisdiction of disease, injury, disability prevention or control and to assist in disaster relief efforts. In addition, about information disclosure at a school in regards to an individual who is a student or a perspective student, if the PHI that is disclosed is limited to proof of immunization.
For Correctional Institutions: Should you be an inmate in a correctional institution, health information may be disclosed to the institution or its agents which would be necessary for your health and safety and the health and safety of other individuals.
For Law Enforcement Agencies: Health information may be disclosed to law enforcement agencies for purposes required by law or subpoena.
For Judicial and General Administrative Proceedings: Patient health information may be released per minimum necessary requirements for proceedings.
For Healthcare Oversight: Patient health information may be used by health oversight agencies for activities such as audits, inspections, and licensure activities.
For Specialized Government Functions: In the event that appropriate military authorities require information, it may be released at the minimum necessary level.
For Victim of Abuse, Neglect, and Domestic Violence: Information may be released to social service agencies or protective services in order to protect an individual.
For Emergency Circumstance: If the opportunity to agree or object to the use or disclosure of phi cannot practically be provided because of your incapacity or in an emergency circumstance, the covered entity may, in the exercise of professional judgment, determine whether the disclosure is in the best interest of the individual and if so disclose only the phi that is directly relevant to the person's involvement with the individual's care or payment.
Examples of uses and disclosures that require an authorization such as psychotherapy notes [where deemed appropriate], participation in research, and marketing that involves financial remuneration, are to be made with your written authorization and you may revoke such authorization at any time as provided by 164.508(b)(5). Other uses and disclosures not described in the notice will be made only with your written authorization
Examples of uses and disclosures requiring an opportunity for the individual to agree
or to object include the following.
A covered entity may disclose, with your agreement, to a family member, other relative, a close personal friend, or any other person identified by you, the phi directly relevant to such person's involvement with your healthcare treatment or payment related to your healthcare episode.
When an individual is deceased, a covered entity may disclose to a family member, or other persons who were involved in the individual's care or payment for health care prior to the individual's death, protected health information of the individual that is relevant to such person's involvement, unless doing so is inconsistent with any prior expressed preference of the individual that is known to covered entity.
Any other uses and disclosures not specified in this Notice will be made only with an authorization from you.
Thank you for reading the Notice of Health Information Practices.
Effective Date: 3/31/2013
Under the Health Insurance Portability and Accountability Act (“HIPAA”), you have
special enrollment rights under certain circumstances.
If you are declining enrollment for yourself, your spouse or other dependents because of other medical insurance or group health plan coverage, you may be able to enroll yourself and your dependents in a Company-sponsored medical plan if you or your dependents lose eligibility for that other coverage (or if the other employer stops contributing toward your or your dependents’ other group health coverage). Effective April 1, 2009, “other coverage” includes other group health plan insurance, Medicaid coverage, or a State’s Children’s Health Insurance Program (CHIP). Additionally, you and/or your dependent(s) may be able to enroll in a Company-sponsored medical plan if you and/or your dependent(s) became eligible for state premium assistance under Medicaid or CHIP. However, you must request enrollment within 30 days after other coverage ends (or after the employer stops contributing toward the other coverage). Note however, you must request enrollment within 60 days of an event that involves loss of Medicaid or CHIP coverage or eligibility for state premium assistance.
In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself, your spouse and your new dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
If you request a change due to a special enrollment event within the applicable timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment.
Qualified change in status
You may also enroll yourself, your spouse and/or your eligible dependents for coverage mid-year in certain circumstances.
Duquesne University extends DUFlex coverage in accordance with Michelle’s Law (Public Law No. 110-381) to eligible dependents who are postsecondary educational students taking a medically necessary leave of absence from school because of a serious illness or injury. Dependent students on medical leave of absence must meet all of the Plan’s other conditions of coverage, to remain eligible for active dependent coverage for 12 months even if the student no longer qualifies as a full-time student. This coverage will continue until the date that is one year after the first day of the medically necessary leave of absence or the date on which such coverage would otherwise terminate under the terms of the DUFlex Plan.
The following requirements must be met:
- Student must be a dependent child who is between the ages of 19 and 24 and enrolled as a full-time student immediately before the first day of the medical leave
- Student must be on an approved medical leave of absence from school due to injury, illness or medical condition
- Treating physician must complete required paperwork which provides written certification of the medical need for leave at least 30 days prior to a foreseeable leave or within 30 days after the start of an unforeseeable leave.
- Certification must state that the leave from school commenced while the child is suffering from a serious illness or injury; that the leave is medically necessary; and that the leave has caused the child to lose student status for purposes of coverage under the terms of this Plan
- Restrict benefits for the length of hospital stay 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).
- Require that a provider obtain authorization from the insurer for prescribing a length of stay of up to 48 hours (or 96 hours).
For details on any state maternity laws that may apply to your medical plan, please refer to the benefit material for the plan in which you are enrolled.
If you or one of your covered dependents 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 for the following services in a manner determined in consultation with the attending physician and the patient:
- 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
- Treatment of physical complications of all stages of the mastectomy, including lymphedemas
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits available under the plan.
For information on WHCRA benefits or details about any state laws that may apply to your medical plan, please refer to the benefit material for the plan in which you are enrolled.
Summary of Benefits and Coverage (SBC)
The SBC is a snapshot of your health plan's costs, benefits, covered health care services, and other features that are important to help you best manage your healthcare. SBCs also explain the health plans' unique features like cost sharing rules and include significant limits and exceptions to coverage in easy-to- understand terms.
Schedule of Benefits (SOB)
The Schedule of Benefits details the costs associated with your healthcare plan, such as the deductible, out-of-pocket maximum amounts, copays and co-insurance amounts for office visits, certain procedures, urgent care and emergency services.