INSCRIPCION ABIERTA 2015 4 de noviembre a 25

Transcripción

INSCRIPCION ABIERTA 2015
4 de noviembre a 25 de noviembre 2014
¿Qué hay dentro?
 ¿Qué es la Inscripción Abierta?



Lo Que Debe Hacer Durante la Inscripción Abierta
Recursos para Inscripción Abierta 2015
 Guías de Inscripción Abierta y Beneficios 2015
 Su guía a la Cuenta de Ahorros de Salud Anthem Lumenos (HSA)
 Cuenta de Gasto Flexibles Limitada (FSA) y la Cuenta de Ahorros de Salud (HSA): Cómo
trabajan juntas
 Reuniones Informativas y Feria de Salud 2015
Contactos de CUC Administración de Beneficios
¿Qué es la Inscripción Abierta?
Inscripción Abierta es su oportunidad anual para realizar cambios en sus opciones de beneficios y
agregar o eliminar la cobertura para dependientes. Inscripción Abierta para sus beneficios 2015
tendrá lugar del 04 de noviembre al 25 de noviembre de 2014. Inscripción abierta seguirá siendo una
Inscripción Activa. Si usted no toma ninguna acción, usted no tendrá cobertura en 2015.
Los beneficios que usted elija durante la Inscripción Abierta serán efectivos el 1 de enero 2015 y
permanecerán vigentes hasta el 31 de diciembre de 2015, a menos que tenga un evento de vida
calificado que le permitirá hacer un cambio a mitad de año.
101 South Mills Avenue, Claremont, CA 91711
(909) 621-8151 (909) 607-7353
2015 Open Enrollment
Page 2
Lo Que Debe Hacer Durante Inscripción Abierta
Todos los empleados deben participar en la Inscripción Abierta para recibir cobertura para el año
2015, con la excepción de algunos de los beneficios que proporciona la compañía. Mientras se
prepara para inscribirse en sus beneficios, le animamos a que:
1. Revise el material de Inscripción Abierta proporcionada en este paquete.
2. Revise los guías de Inscripción Abierta y Beneficios 2015 que puede encontrar en el sitio de
web http://pitweb.pitzer.edu/human-resources/benefits/.
3. Asista a una reunión informativa, vea programa adjunto.
4. Asista a la Feria de Salud 2015, vea el folleto adjunto.
5. Piense en sus beneficios actuales para asegurarse de que sus elecciones se ajusten a sus
necesidades. Si lo hacen, debe volver a inscribirse en estas opciones de beneficios para el
próximo ano. Si no lo hacen, decida lo que hay que cambiar para asegurarse de tener la
cobertura adecuada en 2015.
6. Tenga en cuenta, el mandato individual requiere que usted tendrá que tener cobertura
médica a partir del primero de enero 2015. Si actualmente no tiene cobertura, ahora es el
tiempo para considerar cuidadosamente sus opciones, consulte la información sobre La
Reforma de Salud adjunta.
7. Inicie sesión en UltiPro utilizando el enlace a través de la página web de su escuela lo más
tarde el martes 25 de noviembre para hacer sus elecciones de beneficios para el 2015. Recursos para Inscripción Abierta 2015
Es importante para The Claremont Colleges que usted este bien informado acerca de los beneficios
que se le ofrecen. Le animamos a aprovechar los siguientes recursos para tomar las mejores
decisiones sobre beneficios para usted y su familia:
 Folleto de Inscripción Abierta 2015: El folleto en este paquete le da información general
de los cambios para el 2015, así como las primas para los beneficios.
 Guía de Inscripción Abierta 2015: Este guía electrónico está disponible en el sitio de web
de Pitzer College. El guía describe los cambios para el 2015, lo que tiene que hacer durante
Inscripción Abierta, como inscribirse o hacer cambios y las primas de beneficios para el
2015. Usted puede ver este guía hasta el 25 de noviembre 2014.
(909) 621-8151 (909) 607-7353
Page 3

Guía de Beneficios 2015: El Guía de Beneficios 2015 está disponible como parte del guía
electrónico de Inscripción Abierta que se mencionó anteriormente. Esta guía incluye amplia
información sobre todos los beneficios ofrecidos por The Claremont Colleges. El Guía de
Beneficios 2015 seguirá a su disposición en el sitio web de Pitzer College durante todo el año de
2015.

Su guía para el Plan de Cuenta de Ahorros Anthem Lumenos (HSA): Esta guía
proporciona los detalles sobre cómo el plan y la cuenta HSA trabajan juntos y cómo puede
ahorrar dinero al inscribirse en este plan. Una copia del guía está disponible en la página web de
Pitzer en http://pitweb.pitzer.edu/human-resources/benefits/.

Cuenta de Gasto Flexibles Limitada (FSA) y la Cuenta de Ahorros de Salud (HSA):
Cómo Funcionan Juntas: Este guía describe cómo funciona una cuenta HSA junto con otra
cuenta de ahorro la Cuenta de Gastos Flexibles limitada de Salud (FSA). Una copia del guía está
disponible en la página web http://pitweb.pitzer.edu/human-resources/benefits/.

2015 Inscripción abierta Reuniones Informativas y Feria de Salud y Beneficios: La
Administración de Beneficios CUC está ofreciendo numerosas reuniones informativas durante
toda la Inscripción Abierta para todos los profesores y el personal. La Feria anual de Salud y
Beneficios será el viernes 07 de noviembre 2014 y el bienestar es nuestro principal objetivo.
Durante la feria usted podrá hablar con diferentes representantes de nuestros planes y obtener
información sobre los servicios de bienestar que se pueden utilizar a través de los diferentes
planes para 2015. Las reuniones de información proporcionarán una revisión de los cambios
para el 2015 y da tiempo para que usted pueda hacer preguntas. Las reuniones se presentarán en
inglés y español.
Acceso a los Recursos
Para acceder a estos recursos vaya a http://pitweb.pitzer.edu/human-resources/benefits/. Si esta
acezando estos recursos de una computadora Apple, tendrá que descargar Adobe Acrobat Reader
(en lugar de utilizar el programa "preview" de Apple). Uso de Acrobat asegura que todos los enlaces
y archivos incrustados en el documento funcionen correctamente. Acrobat Reader se puede
descargar de www.adobe.com/downloads.
(909) 621-8151 (909) 607-7353
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Contactos de CUC Administración de Beneficios
CUC Administración de Beneficios está disponible para ayudarle con sus necesidades de Inscripción
Abierta y preguntas. Los representantes de la Administración de Beneficios son:
Carol Saldivar
Mónica Villanueva
Anna Huerta
Claudia Garcia
Alicia Silvia
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
909-607-3195
909-607-3684
909-607-9494
909-607-9493
909-607-4130
El último día de Inscripción Abierta es el 25 de noviembre 2014 a las 5:00 PM PST.
(909) 621-8151 (909) 607-7353
Inscripción Abierta 2015
Noviembre 04 al 25
Fechas Importantes
Martes, 04 de noviembre—Inscripción abierta comienza
Viernes, 07 de noviembre—Feria de Salud
Administrative Campus Center
Martes, 25 de noviembre—Último día de Inscripción Abierta
Inscripción abierta 2015
04 al 25 noviembre
The Claremont Colleges están implementando una inscripción activa para 2015, la inscripción activa significa que los empleados
deben elegir o declinar los beneficios durante la Inscripción abierta activamente. Si no se inscribe de forma activa en el beneficio
deseado, no estará cubierto en el plan en el 2015.
Inscripción Abierta es su oportunidad de hacer cambios en sus elecciones de beneficios, agregar o quitar dependientes, y realizar
cambios en sus cuentas de gastos flexibles. Los beneficios que usted elija durante la inscripción abierta serán efectivos el 01 de
enero 2015 y seguirá en vigor hasta el 31 de diciembre de 2015, a menos que tenga un evento de vida calificado.
Este folleto describe algunos de los cambios y las primas para sus beneficios del 2015, más información se puede encontrar en el
Guía de Beneficios 2015 en http://pitweb.pitzer.edu/human-resources/benefits/.
¿Quién es elegible para los beneficios?
Usted es elegible para participar en los beneficios de e
Claremont Colleges si usted es un empleado regular programado
para trabajar por lo menos 20 horas por semana.
Un empleado elegible para beneficios se define como:
a. Un profesor que está programado para trabajar por lo menos
medio tiempo durante un semestre, con la excepción de
profesor adjunto en Claremont Graduate University (CGU), o
b. Un miembro de la facultad que tiene previsto enseñar
al menos tres clases durante el año académico, o
c. Un miembro del personal en un puesto regular que tiene
previsto a trabajar por lo menos 20 horas a la semana, o
d. Un, empleado basado en donaciones de beneficios-elegibles
en CGU
1. Un empleado contratado en una posición que es financiado
por una subvención incluyendo específicamente expensas
del empleador por beneficiar a la cobertura, y
2. Empleado cumple el número requerido de las horas
programadas de trabajo, definidas anteriormente.
Todos los demás empleados no son elegibles para los beneficios
medicos, a menos que cumplen los requerimientos para
beneficios bajo la ley de Cuidado Asequibles que se define
en la Declaración de Elegibilidad de Beneficios para Programas
Administrados Centralmente de Beneficios disponibles en
www.claremont.edu/benefits.
Dependientes Elegibles
Si se inscribe a sí mismo en la cobertura de e Claremont
Colleges, también puede inscribir a sus dependientes. Los
dependientes elegibles incluyen:
■ Esposo(a) ■ Pareja de hecho
■ Niños hasta 26 años de edad, y los niños de cualquier
edad que están mentalmente o físicamente discapacitados
y cumplen con ciertos requisitos
■ Hijastros o hijos de su pareja de hecho hasta los 26 años
Evento de Vida*
Algunos eventos de vida le permiten hacer cambios a sus
beneficios a mediados de año. Para ser elegible usted debe tener
uno de los siguientes eventos y enviar la documentación a la
Administración de Beneficios dentro de los 30 días del evento.
■ Nacimiento/Adopción ■ Matrimonio/Divorcio
■ Pérdida de cobertura
■ Ganancias de cobertura de sus dependientes
* Por favor, póngase en contacto con su representante de beneficios para
discutir su evento de vida.
Cómo inscribirse
Accede a UltiPro usando su nombre de usuario individuo y
contraseña. Vaya a “Myself ” en la barra de menú y haga clic en
“Open Enrollment”. Haga sus elecciones y haga clic en el botón
“Submit” en la página de confirmación para completar sus
elecciones del 2015. Tenga en cuenta que usted tiene ahora la
capacidad de restablecer sus elecciones en cualquier momento
durante el periodo de Inscripción Abierta.
Para asistencia con su nombre de usuario y contraseña de UltiPro
por favor póngase en contacto con su departamento de Recursos
Humanos.
Cambios en los beneficios 2015
■ Anthem Blue Cross HMO (CaliforniaCare)
■ Sala de emergencias Copago: El copago de visitas a la sala de
emergencia aumentarán de $100 a $150 por visita. Si usted
es admitido en el hospital como consecuencia de su visita de
emergencia, entonces el copago de emergencia no se aplica y
el copago de hospitalización se aplicará.
■ Copago de medicamentos: El copago por medicamentos de
marca aumentarán, como sigue. No habrá ningún cambio
en los copagos de medicamentos genéricos.
■ Medicamento de marca: $25 a $30 de copago.
■ Medicamento de marca fuera del formulario:
$40 a $50 de copago.
■ MetLife PPO
■ Frecuencia de rayos X: Para las personas de 19 años o menos,
Los rayos X de aleta de mordida serán cubiertos una vez
por año.
■ Fluoruro frecuencia de aplicación: Para las personas de
edad 14 o menos, la frecuencia de aplicación de flúor será
cubierto una vez por año.
■ Nuevo Administrador de Cuenta de Gastos Flexibles (FSA)
■ El 1 de enero de 2015, PayFlex reemplazará Benesyst/TASC
como el administrador de FSA. Las cuentas FSA le ayudan
a que su dinero rinda mas, ya que permite ahorrarse sus
dólares antes de impuestos para pagar los gastos de atención
médica fuera de su bolsillo, incluyendo los gastos dentales
y de visión.
Planes Médicos
Beneficios
Káiser HMO
Anthem Blue Cross
Anthem Lumenos HSA
Dentro de la Red
Anthem Lumenos HSA
Fuera de la Red
Deducible por año calendario
Empleado solamente
ninguno
ninguno
$1,500
Empleado + Uno
ninguno
ninguno
$3,000
Incluye empleado asegurado y uno o más miembros
de la familia del empleado
Máximo de Desembolso (por año calendario) Algunos de los beneficios no se aplican hacia el desembolso máximo.
Empleado solamente
$1,500
$1,500
$3,000
$6,000
Empleado + Uno
$3,000
$3,000 (dos personas)/
$4,500 (Familia)
$6,000
$12,000
Servicios para pacientes hospitalizados
Hospitalización
$200 copago
por admisión
$300 copago
por admisión
El Plan paga el 80%
después del deducible
El Plan paga el 60%
Rayos X, Laboratorio
plan paga el 100%
plan paga el 100%
El Plan paga el 80%
El Plan paga el 60%
Servicios para pacientes ambulatorios
Visitas al consultorio
PCP: $20 copago
Especialista: $30 copago
PCP: $25 copago
Especialista: $40 copago
El plan paga el
80% después
del deducible
El plan paga el
60% después
del deducible
Cuidado Preventivo
El plan paga el 100%
El plan paga el 60%
Cirugía Ambulatoria
$30 copago
$100 copago
El plan paga el 80%
El plan paga el 60%
Sala de emergencia
servicios y suministros
$100 copago;
exonerado si hay
admisión
$150 copago;
exonerado si hay
admisión
El plan paga el 80%
El plan paga el 60%
Atencion Hospilataria
$200 por admisión
$300 por admisión
El plan paga el 80%
El plan paga el 60%
Atención Ambulatoria
$20 copago
por visita/terapia
individual que
$10 copago
por visita de terapia/grupo
$25 copago por visita
($40 por especialista)
El plan paga el 80%
El plan paga el 60%
Servicios de Emergencia
Medicamentos recetados- Farmacia (hasta un suministro de 30 días)
Genérico
$10 copago
$10 copago
El plan paga el 80%
El plan paga el 60%
Marca del Formulario
$25 copago
$30 copago
El plan paga el 80%
El plan paga el 60%
Marca No del Formulario
$25 copago
$50 copago
El plan paga el 80%
No Cubierto
Medicamentos recetados—Pedido postal
Genérico
$20 para un máximo de
100 días de suministro
Marca del Formulario
Marca No del Formulario
Planes Dentales
Beneficios
MetLife DHMO
Dentro de la Red
MetLife PPO
Dentro de la Red
MetLife PPO
Fuera de la Red
Deducible por año calendario
Ninguno
Individual $50/ familia $150
Individual $75/ familia $225
Máximo por año Calendario
Ilimitado
El plan paga hasta $2,000
por persona/año
El plan paga hasta $2,000
por persona/año
$0 copago
deducible no se aplica
El plan paga el 90%
deducible no se aplica
Rellenos: Amalgama
compuestas/Resina
$0 a $240 copago
(dependiendo del número
de superficies)
El plan paga el 80%
El plan paga el 80%
Extracciones simples
$5 copago
($30 para visitas fuera del horario)
El plan paga el 80%
El plan paga el 80%
Copagos se enumeran en la
lista de servicios cubiertos
El plan paga el 50%
El plan paga el 50%
Preventivo / Diagnóstico
Examen de rutina:
limpieza una vez cada 6 meses
Servicios generales
Servicios mayores
Capas, coronas, dentaduras
Ortodoncia
Adultos
$1,695 copago
Niños Dependientes (hasta 19 años)
$1,695 copago
Evaluación y Consulta
$100 copago
Plan de Tratamiento y Expedientes
$250 copago
Retención
$250 copago
El plan paga el 50% hasta $2,000 beneficio
máximo de por vida; deducible no se aplica
Planes de Vision
Beneficios
Anthem Blue View
Core Plan
Anthem Blue View
Buy-Up Plan
Examen de la vista (una vez cada 12 meses)
El plan paga el 100% después
de $10 de copago
de $10 de copago
El plan paga hasta $79
35% descuento
recibirá un descuento del 20%
en cantidades más subsidio
Visión de
$50 copago
Bifocal alineado
$70 copago
de $15 de copago
Trifocal alineado
$105 copago
Marcos (una vez cada 12 meses)
Lentes (una vez cada 12 meses)
Lentes de contacto (una vez cada 12 meses)
Usted recibe un descuento del 15%
en el examen de lentes de contacto
El plan paga hasta $ 130 subsidio,
usted recibe un descuento del 15% en
honorarios profesionales del médico.
Los materiales se pagan a tarifas
normales y habituales
2015 Primas Mensuales*
Planes Médicos
Empleado solamente
Empleado más uno
Familia
Anthem Blue Cross HMO
(California Care)
Anthem Lumenos HSA
Káiser HMO
$43.39
$182.23
$390.49
$53.14
$223.19
$477.82
$53.38
$224.42
$482.18
*Impuesto sobre las primas se aplica al momento de inscribir a una pareja de hecho, por favor consulte con su representante de beneficios para obtener información adicional.
Planes Dentales†
Empleado solamente
Empleado más uno
Familia
Planes de Vision
Empleado solamente
Empleado más uno
Familia
Met Life Dental DHMO
Met Life Dental PPO
$5.76
$18.52
$30.00
$56.72
$126.80
$190.52
Vision Core
Vision Buy-Up
$0.00
$1.36
$3.05
$4.48
$7.57
$12.53
2015 Primas Quincenal*
Planes Médicos
Empleado solamente
Empleado más uno
Familia
(California Care)
Anthem Lumenos HSA
Káiser HMO
$20.03
$84.11
$180.23
$24.53
$103.01
$220.53
$24.64
$103.58
$222.54
Planes Dentales†
Empleado solamente
Empleado más uno
Familia
Planes de Vision
Empleado solamente
Empleado más uno
Familia
Met Life Dental PPO
$2.66
$8.55
$13.85
$26.18
$58.52
$87.93
Vision Core
Vision Buy-Up
$0.00
$0.63
$1.41
$2.07
$3.49
$5.78
2015 Primas Mensuales* (Salario Menus de $52,000)
Planes Médicos
Empleado solamente
Empleado más uno
Familia
(California Care)
Anthem Lumenos HSA
Káiser HMO
$39.05
$173.12
$364.46
$47.83
$212.03
$445.96
$53.38
$224.42
$482.18
Planes Dentales†
Empleado solamente
Empleado más uno
Familia
Planes de Vision
Empleado solamente
Empleado más uno
Familia
Met Life Dental PPO
$5.76
$18.52
$30.00
$56.72
$126.80
$190.52
Vision Core
Vision Buy-Up
$0.00
$1.36
$3.05
$4.48
$7.57
$12.53
2015 Primas Quincenal* (Salario Menos de $52,000)
Planes Médicos
Empleado solamente
Empleado más uno
Familia
(California Care)
Anthem Lumenos HSA
Káiser HMO
$18.02
$79.90
$168.21
$22.08
$97.86
$205.83
$24.64
$103.58
$222.54
Planes Dentales
Empleado solamente
Empleado más uno
Familia
Planes de Vision
Empleado solamente
Empleado más uno
Familia
Met Life Dental PPO
$2.66
$8.55
$13.85
$26.18
$58.52
$87.93
Vision Core
Vision Buy-Up
$0.00
$0.63
$1.41
$2.07
$3.49
$5.78
Empleado Precios Mensuales
Seguro de Vida Suplementario
Empleado Primas Mensuales
Muerte Accidental y Desmembramiento (AD&D)
Precios para los empleados y esposo(a)/pareja de hecho se basan
en la edad del empleado del 1 de enero de 2015.
Las cantidades de cobertura de más de 250,000 dólares no podrán exceder
diez veces su salario anual básico. Cantidad de cobertura no se puede
aumentar después de 70 años de edad. Cobertura para los niños es el 30%
de la cantidad principal, hasta un máximo de $50,000.
Anthem Seguro de Vida Suplementario
para esposo(a) o pareja de hecho
Edad
Prima mensual
(por cada $1,000 de cobertura)
Bajo 30
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70 +
$0.05
$0.06
$0.08
$0.14
$0.24
$0.40
$0.62
$0.97
$1.74
$3.11
Seguro de Vida de Niño(s): $0.50 por familia por $5,000 de cobertura.
Beneficios pagados 100% por el empleador
Seguro de Vida Básico
Toda la facultad y personal elegible para los beneficios serán
cubiertos para el Seguro de Vida Básico con un beneficio
de una vez su sueldo anual o un mínimo de $20,000 a un
máximo de $50,000.
Discapacidad a largo plazo
Facultad y personal elegible para los beneficios que están
programados para trabajar 30 horas o más por semana, están
inscritos automáticamente para cobertura de discapacidad a
largo plazo en su primer día de trabajo. Excepción: El personal
de Rancho Santa Ana Botanic Gardens puede elegir la
cobertura y pagar el 50% de la prima.
Programa de Asistencia al Empleado (EAP)
Consejos y asesoramiento confidencial está disponible para
profesores y el personal, sin costo alguno a través de la EAP.
Los empleados y sus esposos(a) legales y dependientes
elegibles reciben hasta cinco sesiones (5) de orientación
con un terapeuta certificada por teléfono o en persona,
por cada miembro de la familia, cada año. El acceso a EAP
está disponible 24/7 durante todo el año.
Suma Principal
Cobertura Solamente
para Empleado
Cobertura
Familiar
$25,000
$50,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$375,000
$400,000
$425,000
$450,000
$475,000
$500,000
$0.50
$1.00
$1.50
$2.00
$2.50
$3.00
$3.50
$4.00
$4.50
$5.00
$5.50
$6.00
$6.50
$7.00
$7.50
$8.00
$8.50
$9.00
$9.50
$10.00
$0.98
$1.95
$2.93
$3.90
$4.88
$5.85
$6.83
$7.80
$8.78
$9.75
$10.73
$11.70
$12.68
$13.65
$14.63
$15.60
$16.58
$17.55
$18.53
$19.50
Administración de Beneficios Contactos
Claremont University Consortium
Carol Saldivar (909) 607-3195
[email protected]
Anna Huerta (909) 607-9494
[email protected]
Claudia Garcia (909) 607-9493
[email protected]
Monica Villanueva (909) 607-3684
[email protected]
Para obtener más información, por favor vea
el guía de Inscripción Abierta y Beneficios 2015
en http://pitweb.pitzer.edu/human-resources/benefits/ .
cuc ba 10/14
The Claremont Colleges Inscripción Abierta 2015
4 a 25 noviembre, 2014
El Período de Inscripción Abierta Anual Para Seguros Médico, Dental, Visión,
Cuentas de Gastos Flexibles y Seguro de Vida está aquí.
Juntas Informativas
Estas reuniones incluyen una presentación sobre los cambios de beneficios para 2015, así como una oportunidad
para hacer preguntas y hablar con un Representante de Beneficios de la Administración de Beneficios CUC.
Tenga en cuenta que cada sesión se adapta a mejorar el plan medico HMO o de HSA. Están bienvenidos asistir
a una reunión para cada presentación designada.
Pomona College
Claremont Graduate University
Harvey Mudd College
■ Jueves, 06 de noviembre
Smith Campus Center, Room 208
HMO 11:00 a.m. (Inglés)
■ Martes, 11 de noviembre
Frank Dining Hall, Blue Room
Union—No Medica
2:00–4:00 p.m. (Inglés/Español)
■ Miercoles, 12 de noviembre
Smith Campus Center, Rose Hills
Theatre and Lobby
HSA 3:45 p.m. (Inglés)
Smith Campus Center, Room 208
HMO 9:00 a.m. (Español)
Stauffer Auditorium
HSA 9:00 a.m. (Inglés)
Burkle #16
Shanahan Center, Room 1480
Hoch Shanahan Dining Commons,
Aviation Room
HMO 2:30 p.m. (Español)
Shanahan Center, Room 1480
Claremont McKenna College
McConnell Center, Founder’s Room
HSA 10:00 a.m. (Español)
McConnell Center, Founder’s Room
HMO 12:15 p.m. (Inglés)
Claremont University Consortium
ACC, Oak Room
Scripps College
Malott Commons
Vita Nova Hall
Bauer Center, Founders Room
Pickford Auditorium
Pickford Auditorium
HSA/HMO 2:00–4:00 p.m.
(Inglés/Español)
Bauer Center, Founders Room
Pickford Auditorium
HMO 1:30 p.m. ( Inglés)
Rancho Santa Ana
Botanical Garden
Main Building, East Classroom
Pitzer College
Keck Graduate Institute
Bldg. 535 Watson #152
■ Viernes, 14 de noviembre
The Claremont Colleges
Feria Anual de Salud y Beneficios
Viernes 07 de noviembre 2014
10:00 a.m.–2:00 p.m.
101 South Mills Avenue (por First Street)
Servicio de transporte disponible, vea el reverso para obtener más información
Feria de la Salud
Marque su calendario—no se pierda la oportunidad de hablar con sus
portadores de seguro, obtengan información divertida y útil acerca
de sus planes, y habrá exámenes de salud gratuitos.
■ American Red Cross
Al donar sangre recibira cinco boletos para la rifa
■ Exámenes de Salud
■ Aprenda a sembrar su propio jardín de hierbas—demostración
■ Demostraciones de jugos verdes y muestras
■ Masajes de 15 minutos por terapeutas certificados
■ Regalos gratis
■ Disfrute de una merienda saludable
Jamba Juice, brochetas de fruta fresca, Subway, Yogurtland
■ Mercado de Frutas—muestras
■ Apuntase a la rifa para ganar una bicicleta de la playa o un Fitbit!
■ Vengan a jugar nuestro juego Spin-the-Wheel, y ganen un premio!
Feria Anual de Salud y Beneficios
Viernes 07 de noviembre 2014
10:00 a.m.–2:00 p.m.
Comparten sus vehículos al evento y reciban un boleto de rifa adicional.
Puntos de Servicio de Translado
Los transportes funcionan aproximadamente cada 15–20 minutos en cada lugar.
■ Harvey Mudd College
Kingston Hall Visitors Parking Lot (Platt Boulevard)
■ Pomona College
Frank Hall (Columbia and Bonita)
and Edmunds Ballroom (Sixth and College)
■ Scripps College
Balch Hall Courtyard (Ninth and Columbia)
■ Claremont Graduate University
Stauffer Hall (Tenth and Dartmouth)
■ Claremont McKenna College
Collins Dining Hall West Entrance (Eighth and Amherst)
■ Pitzer College
Sanborn Parking Lot (Ninth and Mills)
Ofertas de Bienestar
de Sus Portadores
Además de la feria anual de la salud, nuestros portadores de planes médicos también ofrecen
una serie de servicios de salud y bienestar que están cubiertos de forma gratuita en sus planes
médicos. Para obtener más información acerca de estos servicios valiosos póngase en contacto
con su proveedor de plan.
and Lumenos HSA
Atención preventiva gratuita (miembros de HMO y
dentro de la red para los miembros Lumenos HSA)
inmunizaciones gratuitas, como la vacuna contra la
gripe anual y la vacuna contra la neumonía.
24/7 línea de enfermería ofrece una enfermera de
guardia al que puede llamar en cualquier momento,
de día o de noche.
Programa para futuras madres proporcionado
como un recurso sin costo a las mujeres embarazadas
que desean acceder a las enfermeras y especialistas
para asesoramiento, información de salud,
y exámenes de salud.
Condition Care proporciona enfermeras para
asesoramiento y otros recursos a los miembros
afectados por los problemas de salud crónicos
y de largo plazo como el asma, la diabetes
y la insuficiencia cardíaca.
LiveHealth Online (LHO) le da rápido y fácil acceso
a médicos, incluyendo chats de vídeo privados 24/7.
Consultas LHO están cubiertos por su copago regular.
MyHealth Record es una característica de la página
web de Anthem que mantiene sus registros médicos
y vacunaciónes.
360°Health ofrece una biblioteca en línea
de información y herramientas relacionadas con
la salud para ayudar a los miembros con cualquier
cosa, desde la gestión de una condición hasta
la organización de los registros de salud.
Descuentos con los proveedores de atención
oftalmológica y cuidado de los ojos, tales como
Premier LASIK
Descuentos en los programas de salud y gimnasios,
tales como Weight Watchers y Gold’s Gym
Kaiser Permanente HMO
Cuidado preventivo gratuito
Inmunizaciones gratuitas, como la vacuna contra
la gripe anual y la vacuna contra la neumonía
Los programas de estilo de vida saludables están
disponibles para los miembros; estos programas
cubren:
■ Evaluación de la Salud
■ Maternidad y el embarazo
■ Manejo del Dolor
■ Pérdida de peso
■ Nutrición
■ Para dejar de fumar
■ Depresión y manejo del estrés
■ Insomnio
■ Gestión de la Diabetes
■ Gestión condición crónica
Coaching de bienestar anima a los miembros
a enfocarse en iniciativas de salud y de mejora
su bienestar.
My Health Manager mantiene todos los registros
médicos, recordatorios de salud y permite a los
miembros reservar y/o cancelar citas.
ChooseHealthy es un sitio web que ofrece
descuentos en gimnasios de salud y otros recursos
que mejoran la salud, tales como libros de salud,
videos y ejercicios personalizados y planes
de nutrición.
Descuentos en servicios de cuidados alternativos
como acupuntura o terapia de masaje
Reforma de la Atención
de la Salud en 2015
Como usted sabe, la Ley de Cuidado de Salud
a Bajo Precio (Affordable Care Act—ACA),
también conocida como “Reformas del Sistema
de Salud” o “Health Care Reform” fue
promulgada en 2010. Esta ley está destinada
a extender el acceso a cobertura médica a la
mayoría de las personas en los Estados Unidos,
y eliminar restricciones a beneficios claves.
A partir de enero de 2014, la ACA incluye el
mandato individual, que requiere que casi todos
los estadounidenses tengan cobertura médica
o paguen una multa cuando presenten los
impuestos. Cobertura a través de The Claremont
Colleges es probable su mejor opción para
cumplir con el mandato individual. Los planes
que se ofrecen a través de The Claremont
Colleges son completos y asequibles. Sin
embargo, si usted no es elegible para la
cobertura a través de The Claremont Colleges,
hay varios recursos que puede utilizar para
encontrar cobertura. No se le puede negar
la cobertura a través de estos mercados de
seguros públicos, y usted puede ser elegible
para los créditos fiscales que reducen
el costo de seguro de salud. Inscripción Abierta
para estos mercados públicos comienza
el 15 de noviembre 2014, y la fecha límite para
inscribirse en la cobertura efectiva a partir
del 01 de enero 2015 es el 15 de diciembre 2014.
GetInsured
A través de GetInsured usted puede comparar
los planes de seguro de salud y encontrar
el que mejor se adapte a sus necesidades
y presupuesto, usted puede averiguar si usted
es elegible para los créditos fiscales que
reducirán sus costos de cobertura, y puede
inscribirse en un plan que satisface
específicamente sus necesidades médicas.
Cada plan incluye grandes beneficios como
visitas al médico, cuidado preventivo,
medicamentos, control de la natalidad
y la atención de emergencia. Con GetInsured,
un agente con licencia puede ayudarle a
navegar sus opciones de seguro, a determinar
si usted es elegible para créditos de impuestos,
y le ayudará inscribirse para que su cobertura
pueda comenzar el 1 de enero de 2015.
Llame al 877-917-7957
O visite www.getinsured.com/mercer
para servicios personalizados
CoveredCA
El estado de California ofrece un mercado
seguro público para los residentes de California
que necesitan cobertura de salud. Visite
www.CoveredCA.com para explorar una
variedad de planes de seguro integrales
en que se puede inscribirse para la cobertura
al partir del 01 de enero 2015.
Important notice from The Claremont Colleges about creditable
prescription drug coverage and Medicare
Date of this notice: October 2014
The purpose of this notice is to advise you that the prescription drug coverage listed below under
The Claremont Colleges medical plan is expected to pay out, on average, at least as much as the
standard Medicare prescription drug coverage will pay in 2015. This is known as “creditable
coverage.”
Why this is important. If you or your covered dependent(s) are enrolled in any prescription drug
coverage during 2015 listed in this notice and are or become covered by Medicare, you may
decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment
penalty – as long as you had creditable coverage within 63 days of your Medicare prescription
drug plan enrollment. You should keep this notice with your important records.
If you or your family members aren’t currently covered by Medicare and won’t become covered by
Medicare in the next 12 months, this notice doesn’t apply to you.
Please read the notice below carefully. It has information about prescription drug coverage with
Claremont and prescription drug coverage available for people with Medicare. It also tells you
where to find more information to help you make decisions about your prescription drug coverage.
Notice of creditable coverage
You may have heard about Medicare’s prescription drug coverage (called Part D), and wondered
how it would affect you. Prescription drug coverage is available to everyone with Medicare
through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a
standard level of coverage set by Medicare. Some plans also offer more coverage for a higher
monthly premium.
Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and
each year from October 15 through December 7. Individuals leaving employer/union coverage
may be eligible for a Medicare Special Enrollment Period.
If you are covered by one of the Claremont prescription drug plans listed below, you’ll be
interested to know that coverage is, on average, at least as good as standard Medicare
prescription drug coverage for 2015. This is called creditable coverage. Coverage under the plans
listed below will help you avoid a late Part D enrollment penalty if you are or become eligible for
Medicare and later decide to enroll in a Medicare prescription drug plan:
•
•
•
Kaiser HMO
Anthem Lumenos HSA
If you decide to enroll in a Medicare prescription drug plan and you are an active employee or
family member of an active employee, you may also continue your employer coverage. In this
case, the employer plan will continue to pay primary or secondary as it had before you enrolled in
a Medicare prescription drug plan.
If you waive or drop Claremont coverage, Medicare will be your only payer. You can re-enroll in
the employer plan at annual enrollment or if you have a special enrollment event for the
Claremont plan.
Page 2
You should know that if you waive or leave coverage with Claremont and you go 63 days or
longer without creditable prescription drug coverage (once your applicable Medicare enrollment
period ends), your monthly Part D premium will go up at least 1% per month for every month that
you did not have creditable coverage. For example, if you go 19 months without coverage, your
Medicare prescription drug plan premium will always be at least 19% higher than what most other
people pay. You’ll have to pay this higher premium as long as you have Medicare prescription
drug coverage. In addition, you may have to wait until the following October to enroll in Part D.
You may receive this notice at other times in the future – such as before the next period you can
enroll in Medicare prescription drug coverage, if this Claremont coverage changes, or upon your
request.
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. Medicare participants will get a copy of the handbook in the mail
every year from Medicare. You may also be contacted directly by Medicare prescription drug
plans. Here’s how to get more information about Medicare prescription drug plans:
•
Visit www.medicare.gov for personalized help.
•
Call your State Health Insurance Assistance Program (see a copy of the Medicare & You
handbook for the telephone number).
•
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for a Medicare prescription drug
plan is available. Information about this extra help is available from the Social Security
Administration (SSA). For more information about this extra help, visit SSA online at
www.socialsecurity.gov or call 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in a Medicare prescription drug plan after your
applicable Medicare enrollment period ends, you may need to provide a copy of this notice when
you join a Part D plan to show that you are not required to pay a higher Part D premium amount.
For more information about this notice or your prescription drug coverage, contact:
CUC Benefits Administration
101 S. Mills Avenue
Claremont, CA 91711
909-621-8151
Initial Notice of COBRA Continuation Coverage Rights
The Claremont Colleges – CUC Benefits Administration
101 S. Mills Avenue, Claremont, CA 91711 (909) 621-8151
RETAIN THIS NOTICE WITH
YOUR INSURANCE PAPERS
Date of Notice: October 2014
IMPORTANT NOTICE: YOUR RIGHTS UNDER COBRA IN THE EVENT THAT YOU LOSE
INSURANCE COVERAGE
Employees, spouses and any adult dependents (if applicable) should read this notice carefully. If you
have adult dependents covered under benefit plans who reside at a different address, either forward them
a copy of this notice or inform PayFlex, our COBRA administrator, in writing of the name and address of
the dependent. PayFlex will send them a separate copy of this notice.
Federal Law requires that The Claremont Colleges, as a sponsor of group health plans, offer employees and their
eligible family members the opportunity for a temporary extension of health coverage called “continuation
coverage” at group rates in certain instances where coverage under the plan would otherwise end. This notice is
intended to inform you of your rights and obligations under federal law. You may have other rights under
applicable state law. Where state law supersedes federal law, The Claremont Colleges and its administrators will
make every reasonable effort to apply the appropriate statutes.
Under COBRA law if you, as an employee of The Claremont Colleges, have coverage under our group
health insurance plans, you have the right to choose continuation coverage equivalent to the eligible insurance in
effect on the date you terminated or were laid off from employment if:
1. You have a reduction in employment hours to less than the number of hours per week required to qualify
for benefits.
2. Your employment terminates for reasons other than gross misconduct.
3. You retire.
4. Your employer files for reorganization under Chapter 11 (but you are not yet eligible for Medicare).
5. You become disabled under Title II or XVI of the Social Security Act within 60 days of one of the above
events.
If you are a Spouse of an employee (or a retiree for reason [5] below,) covered by The Claremont Colleges
group health plan(s), you have the right to continue coverage for yourself if you lose our group health insurance
coverage(s) for any of the following reasons:
1. The death of your spouse.
2. Termination of your spouse's employment from The Claremont Colleges (for reasons other than gross
misconduct) or reduction in your spouse's hours of employment to less than those required to qualify for
applicable benefits.
3. Divorce or legal separation from your spouse, even if coverage was terminated in anticipation of divorce or
legal separation. NOTE: Coverage will only be provided from the date of the divorce, and you must
inform The Claremont Colleges or its designated agent, PayFlex, of the divorce.
4. Your spouse becomes entitled (that is, covered) under Medicare (but you are not eligible for Medicare).
5. Your spouse’s employer files for Chapter 11 reorganization.
Dependent children of employees (or retirees for reason [6] below) covered by The Claremont
Colleges group health plan(s) also have the right to continue coverage if group insurance coverage under
The Claremont Colleges group health plan(s) is lost for any of the following reasons:
1.
2.
3.
4.
5.
6.
7.
The death of a parent who was an employee of The Claremont Colleges
The termination of a parent's employment (for reasons other than gross misconduct).
A parent's divorce or legal separation.
A parent becomes entitled (that is, covered) under Medicare.
The parent’s hours have been reduced to less than those required to qualify for benefits.
The parent's employer files for Chapter 11 reorganization.
The child reaches majority age, or student status expires under the terms of the health plan.
Under the law, the employee or a family member must inform The Claremont Colleges in writing of a “Qualifying
Event” such as divorce, legal separation, Social Security determination that the employee was disabled at the time
of the employee's termination or reduction in hours, or of a child losing dependent status under The Claremont
Colleges group health plan(s) within 60 days. When The Claremont Colleges is notified that one of these events
has occurred, The Claremont Colleges or its designated agent will, in turn, notify you (or your eligible dependent)
of your continuation coverage options and cost.
If you do not choose to continue your coverage, your group health insurance through The Claremont Colleges will
end.
If you choose to continue coverage, The Claremont Colleges will provide coverage identical to that provided to
active, similarly situated eligible employees or their eligible dependents. COBRA continuation law requires that you
be allowed the opportunity to maintain continuation coverage for:
General Notice – Federal
Page 1
1. 18 months from the date your group health coverage(s) ended for reasons of termination of employment,
or a qualifying reduction in hours.
2. 29 months for employees and dependents under Federal Law who have informed The Claremont Colleges
or its designated agent in writing, anytime during your 18 months standard COBRA coverage period, that
Social Security has determined that you were disabled within the first 60 days your COBRA coverage.
3. 36 months for dependent children ceasing to qualify as dependents under our group health plan(s).
4. 36 months maximum for divorce under Federal continuation law.
5. 36 months maximum (applies to dependents), in cases of retirement from active employment at an age
where you become entitled to Medicare. (See termination of Continuation Coverage below also.).
6. 36 months for retirees and spouses of retirees should the Employer files for Chapter 11 Bankruptcy under
Federal Law.
If, during your 18-month continuation period, you experience a second event from the above listed Qualifying
Events, which causes a loss of coverage, your coverage may be extended up to a maximum of 36 months of
COBRA coverage. The former employee or a family member must notify The Claremont Colleges or its agent
when a second event occurs.
Note: If state laws supersede federal laws in your situation, The Claremont Colleges will make every reasonable
effort to continue coverage in accordance with the applicable statutes. In most, but not all cases the total length of
continuation of coverage will range from 18 to 36 months.
TERMINATION OF CONTINUATION COVERAGE
The law also provides that your continuation may terminate earlier than the period indicated above for any of the
following reasons:
1. The Claremont Colleges no longer provides group health coverage to similarly situated employees.
2. The premium for your continuation coverage is not paid in a timely fashion.
3. You become covered under another group health plan that does not include a pre-existing condition clause
that would apply to you or a covered dependent.
4. You become entitled to (that is, covered under) Medicare. NOTE: Medicare coverage in effect prior to
COBRA will not prevent you from electing continuation coverage under COBRA.
5. If you are in the months 19-29 of a disability extension and a final determination has been made that you
are no longer disabled. Termination of coverage is effective in the month that begins after 30 days from
the date of the final determination.
You do not have to show that you are insurable to choose continuation coverage. To continue coverage under the
law, you will have to pay all of the premium due plus an administrative charge, as permitted by law.
You have 60 days to elect COBRA continuation coverage.
You will have 45 days from the date you elect COBRA continuation coverage to make your initial premium
payment. However, your initial premium payment is required to include all premiums due back to the date
coverage would (otherwise) have ceased, in addition to all current premiums due. All initial premiums are to be
paid in one lump sum, and thereafter on a monthly basis.
Future premiums will be due in advance and by the first of the month for which continuation coverage is desired.
After your first premium payment you will have a grace period of 30 days to pay future monthly premiums. The
Federal Law also states that, at the end of 18 months, 29 months or three year continuation coverage period you
must be allowed to enroll in an individual “conversion health plan” provided under The Claremont Colleges group
health plan(s), if The Claremont Colleges plan includes conversion coverage. The person on continuation coverage
must submit a written application for the conversion policy within 31 days after applicable continuation coverage
ends. Applicants for a conversion policy will not be required to provide evidence of insurability. Read the
Summary Plan Description relating to your plan for more detailed information and to determine if conversion is
available.
If you (as an employee or dependent) have changed marital status or any covered person(s) have changed
addresses, please notify The Claremont Colleges in writing at the address below:
CUC Benefits Administration
101 S. Mills Avenue
Claremont, CA 91711
If you are eligible for or are currently on Continuation Coverage, please notify our designated agent for
continuation coverage administration:
PayFlex
PO Box 2239
Omaha, NE 68103-2239
General Notice – Federal
Page 2
PRIVACY NOTICE
______________________________________________________________________________
Please carefully review this notice. It describes how medical information about
you may be used and disclosed and how you can get access to this information.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous
requirements on the use and disclosure of individual health information by employer health
plans. This information, known as protected health information, includes almost all individually
identifiable health information held by a plan – whether received in writing, in an electronic
medium, or as an oral communication. This notice describes the privacy practices of these plans:
Medical, Prescription Drug, Dental, Vision, Health Savings Account, and Health Care Flexible
Spending Arrangement (FSA) benefits. The plans covered by this notice may share health
information with each other to carry out treatment, payment, or health care operations. These
plans are collectively referred to as the Plan in this notice, unless specified otherwise.
The Plan’s duties with respect to health information about you
The Plan is required by law to maintain the privacy of your health information and to provide
you with this notice of the Plan’s legal duties and privacy practices with respect to your health
information. If you participate in an insured plan option, you will receive a notice directly from
the Insurer. It’s important to note that these rules apply to the Plan, not The Claremont Colleges
as an employer – that’s the way the HIPAA rules work. Different policies may apply to the other
Claremont Colleges’ programs or to data unrelated to these Plans.
How the Plan may use or disclose your health information
The privacy rules generally allow the use and disclosure of your health information without your
permission (known as an authorization) for purposes of health care treatment, payment activities,
and health care operations. Here are some examples of what that might entail:

Treatment includes providing, coordinating, or managing health care by one or more health
care providers or doctors. Treatment can also include coordination or management of care
between a provider and a third party, and consultation and referrals between providers. For
example, the Plan may share your health information with physicians who are treating you.

Payment includes activities by this Plan, other plans, or providers to obtain premiums, make
coverage determinations, and provide reimbursement for health care. This can include
eligibility determinations, reviewing services for medical necessity or appropriateness,
utilization management activities, claims management, and billing; as well as “behind the
scenes” plan functions such as risk adjustment, collection, or reinsurance.
Page 2
For example, the Plan may share information about your coverage or the expenses you have
incurred with another health plan in order to coordinate payment of benefits.

Health care operations include activities by this Plan (and in limited circumstances other
plans or providers) such as wellness and risk assessment programs, quality assessment and
improvement activities, customer service, and internal grievance resolution. Health care
operations also include vendor evaluations, credentialing, training, accreditation activities,
underwriting, premium rating, arranging for medical review and audit activities, and business
planning and development. For example, the Plan may use information about your claims to
audit the third parties that approve payment for Plan benefits.
The amount of health information used, disclosed or requested will be limited and, when needed,
restricted to the minimum necessary to accomplish the intended purposes, as defined under the
HIPAA rules. If the Plan uses or discloses Protected Health Information (PHI) for underwriting
purposes, the Plan will not use or disclose PHI that is your genetic information for such
purposes. The Plan may contact you to provide appointment reminders or information about
treatment alternatives or other health-related benefits and services that may be of interest to you,
as permitted by law.
How the Plan may share your health information with The Claremont Colleges
The Plan, or its health insurer or HMO, may disclose your health information without your
written authorization to The Claremont Colleges for plan administration purposes. The
Claremont Colleges may need your health information to administer benefits under the Plan. The
Claremont Colleges agrees not to use or disclose your health information other than as permitted
or required by the Plan documents and by law. The benefits staff, payroll and finance are the
only employees of The Claremont Colleges employees who will have access to your health
information for plan administration functions.
Here’s how additional information may be shared between the Plan and The Claremont
Colleges, as allowed under the HIPAA rules:

The Plan, or its insurer or HMO, may disclose “summary health information” to The
Claremont Colleges if requested, for purposes of obtaining premium bids to provide coverage
under the Plan, or for modifying, amending, or terminating the Plan. Summary health
information is information that summarizes participants’ claims information, from which
names and other identifying information have been removed.

The Plan, or its insurer or HMO, may disclose to The Claremont Colleges information on
whether an individual is participating in the Plan or has enrolled or disenrolled in an
insurance option or HMO offered by the Plan.
Page 3
In addition, you should know that The Claremont Colleges cannot and will not use health
information obtained from the Plan for any employment-related actions. However, health
information collected by The Claremont Colleges from other sources, for example under the
Family and Medical Leave Act, Americans with Disabilities Act, or workers’ compensation is
not protected under HIPAA (although this type of information may be protected under other
federal or state laws).
Other allowable uses or disclosures of your health information
In certain cases, your health information can be disclosed without authorization to a family
member, close friend, or other person you identify who is involved in your care or payment for
your care. Information about your location, general condition, or death may be provided to a
similar person (or to a public or private entity authorized to assist in disaster relief efforts).
You’ll generally be given the chance to agree or object to these disclosures (although exceptions
may be made – for example, if you’re not present or if you’re incapacitated). In addition, your
health information may be disclosed without authorization to your legal representative.
The Plan also is allowed to use or disclose your health information without your written
authorization for the following activities:
Workers’
compensation
Disclosures to workers’ compensation or similar legal programs that provide
benefits for work-related injuries or illness without regard to fault, as
authorized by and necessary to comply with the laws
Necessary to
prevent serious
threat to health or
safety
Disclosures made in the good-faith belief that releasing your health
information is necessary to prevent or lessen a serious and imminent threat
to public or personal health or safety, if made to someone reasonably able to
prevent or lessen the threat (or to the target of the threat); includes
disclosures to help law enforcement officials identify or apprehend an
individual who has admitted participation in a violent crime that the Plan
reasonably believes may have caused serious physical harm to a victim, or
where it appears the individual has escaped from prison or from lawful
custody
Public health
activities
Disclosures authorized by law to persons who may be at risk of contracting
or spreading a disease or condition; disclosures to public health authorities
to prevent or control disease or report child abuse or neglect; and
disclosures to the Food and Drug Administration to collect or report adverse
events or product defects
Victims of abuse,
neglect, or
domestic violence
Disclosures to government authorities, including social services or protected
services agencies authorized by law to receive reports of abuse, neglect, or
domestic violence, as required by law or if you agree or the Plan believes
that disclosure is necessary to prevent serious harm to you or potential
victims (you’ll be notified of the Plan’s disclosure if informing you won’t put
you at further risk)
Judicial and
administrative
proceedings
Disclosures in response to a court or administrative order, subpoena,
discovery request, or other lawful process (the Plan may be required to notify
you of the request or receive satisfactory assurance from the party seeking
your health information that efforts were made to notify you or to obtain a
qualified protective order concerning the information)
Page 4
Law enforcement
purposes
Disclosures to law enforcement officials required by law or legal process, or
to identify a suspect, fugitive, witness, or missing person; disclosures about
a crime victim if you agree or if disclosure is necessary for immediate law
enforcement activity; disclosure about a death that may have resulted from
criminal conduct; and disclosure to provide evidence of criminal conduct on
the Plan’s premises
Decedents
Disclosures to a coroner or medical examiner to identify the deceased or
determine cause of death; and to funeral directors to carry out their duties
Organ, eye, or
tissue donation
Disclosures to organ procurement organizations or other entities to facilitate
organ, eye, or tissue donation and transplantation after death
Research
purposes
Disclosures subject to approval by institutional or private privacy review
boards, subject to certain assurances and representations by researchers
about the necessity of using your health information and the treatment of the
information during a research project
Health oversight
activities
Disclosures to health agencies for activities authorized by law (audits,
inspections, investigations, or licensing actions) for oversight of the health
care system, government benefits programs for which health information is
relevant to beneficiary eligibility, and compliance with regulatory programs or
civil rights laws
Specialized
government
functions
Disclosures about individuals who are Armed Forces personnel or foreign
military personnel under appropriate military command; disclosures to
authorized federal officials for national security or intelligence activities; and
disclosures to correctional facilities or custodial law enforcement officials
about inmates
HHS investigations
Disclosures of your health information to the Department of Health and
Human Services to investigate or determine the Plan’s compliance with the
HIPAA privacy rule
Except as described in this notice, other uses and disclosures will be made only with your written
authorization. You may revoke your authorization as allowed under the HIPAA rules. However,
you can’t revoke your authorization with respect to disclosures the Plan has already made. You
will be notified of any unauthorized access, use or disclosure of your unsecured health
information as required by law.
Your individual rights
You have the following rights with respect to your health information the Plan maintains. These
rights are subject to certain limitations, as discussed below. This section of the notice describes
how you may exercise each individual right. See the table at the end of this notice for
information on how to submit requests.
Right to request restrictions on certain uses and disclosures of your health information
and the Plan’s right to refuse
You have the right to ask the Plan to restrict the use and disclosure of your health information for
treatment, payment, or health care operations, except for uses or disclosures required by law.
Page 5
You have the right to ask the Plan to restrict the use and disclosure of your health information to
family members, close friends, or other persons you identify as being involved in your care or
payment for your care. You also have the right to ask the Plan to restrict use and disclosure of
health information to notify those persons of your location, general condition, or death – or to
coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise
this right, your request to the Plan must be in writing.
The Plan is not required to agree to a requested restriction. If the Plan does agree, a restriction
may later be terminated by your written request, by agreement between you and the Plan
(including an oral agreement), or unilaterally by the Plan for health information created or
received after you’re notified that the Plan has removed the restrictions. The Plan may also
disclose health information about you if you need emergency treatment, even if the Plan has
agreed to a restriction.
Effective February 17, 2010, an entity covered by these HIPAA rules (such as your health care
provider) or its business associate must comply with your request that health information
regarding a specific health care item or service not be disclosed to the Plan for purposes of
payment or health care operations if you have paid for the item or service, in full out of pocket.
Right to receive confidential communications of your health information
If you think that disclosure of your health information by the usual means could endanger you in
some way, the Plan will accommodate reasonable requests to receive communications of health
information from the Plan by alternative means or at alternative locations.
If you want to exercise this right, your request to the Plan must be in writing and you must
include a statement that disclosure of all or part of the information could endanger you.
Right to inspect and copy your health information
With certain exceptions, you have the right to inspect or obtain a copy of your health information
in a “designated record set.” This may include medical and billing records maintained for a
health care provider; enrollment, payment, claims adjudication, and case or medical management
record systems maintained by a plan; or a group of records the Plan uses to make decisions about
individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes
or information compiled for civil, criminal, or administrative proceedings. The Plan may deny
your right to access, although in certain circumstances you may request a review of the denial.
If you want to exercise this right, your request to the Plan must be in writing. Within 30 days of
receipt of your request (60 days if the health information is not accessible onsite), the Plan will
provide you with:

the access or copies you requested;
Page 6

a written denial that explains why your request was denied and any rights you may have to
have the denial reviewed or file a complaint; or

a written statement that the time period for reviewing your request will be extended for no
more than 30 more days, along with the reasons for the delay and the date by which the Plan
expects to address your request.
The Plan may provide you with a summary or explanation of the information instead of access to
or copies of your health information, if you agree in advance and pay any applicable fees. The
Plan also may charge reasonable fees for copies or postage.
If the Plan doesn’t maintain the health information but knows where it is maintained, you will be
informed of where to direct your request.
Effective February 17, 2010, you may request an electronic copy of your health information if it
is maintained in an electronic health record. You may also request that such electronic health
information be sent to another entity or person, so long as that request is clear, conspicuous and
specific. Any charge that is assessed to you for these copies, if any, must be reasonable and
based on the Plan’s cost.
Right to amend your health information that is inaccurate or incomplete
With certain exceptions, you have a right to request that the Plan amend your health information
in a designated record set. The Plan may deny your request for a number of reasons. For
example, your request may be denied if the health information is accurate and complete, was not
created by the Plan (unless the person or entity that created the information is no longer
available), is not part of the designated record set, or is not available for inspection (e.g.,
psychotherapy notes or information compiled for civil, criminal, or administrative proceedings).
If you want to exercise this right, your request to the Plan must be in writing, and you must
include a statement to support the requested amendment. Within 60 days of receipt of your
request, the Plan will:

make the amendment as requested;

provide a written denial that explains why your request was denied and any rights you may
have to disagree or file a complaint; or

provide a written statement that the time period for reviewing your request will be extended
for no more than 30 more days, along with the reasons for the delay and the date by which
the Plan expects to address your request.
Page 7
Right to receive an accounting of disclosures of your health information
You have the right to a list of certain disclosures of your health information the Plan has made.
This is often referred to as an “accounting of disclosures.” You generally may receive this
accounting if the disclosure is required by law, in connection with public health activities, or in
similar situations listed in the table earlier in this notice, unless otherwise indicated below.
You may receive information on disclosures of your health information for up to six years before
the date of your request. You do not have a right to receive an accounting of any disclosures
made:

for treatment, payment, or health care operations;

to you about your own health information;

incidental to other permitted or required disclosures;

where authorization was provided;

to family members or friends involved in your care (where disclosure is permitted without
authorization);

for national security or intelligence purposes or to correctional institutions or law
enforcement officials in certain circumstances; or

as part of a “limited data set” (health information that excludes certain identifying
information).
In addition, your right to an accounting of disclosures to a health oversight agency or law
enforcement official may be suspended at the request of the agency or official.
If you want to exercise this right, your request to the Plan must be in writing. Within 60 days of
the request, the Plan will provide you with the list of disclosures or a written statement that the
time period for providing this list will be extended for no more than 30 more days, along with the
reasons for the delay and the date by which the Plan expects to address your request. You may
make one request in any 12-month period at no cost to you, but the Plan may charge a fee for
subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change
or revoke your request.
Right to obtain a paper copy of this notice from the Plan upon request
You have the right to obtain a paper copy of this privacy notice upon request. Even individuals
who agreed to receive this notice electronically may request a paper copy at any time.
Page 8
Changes to the information in this notice
The Plan must abide by the terms of the privacy notice currently in effect. This notice takes
effect on October 22, 2011. However, the Plan reserves the right to change the terms of its
privacy policies, as described in this notice, at any time and to make new provisions effective for
all health information that the Plan maintains. This includes health information that was
previously created or received, not just health information created or received after the policy is
changed. If changes are made to the Plan’s privacy policies described in this notice, you will be
provided with a revised privacy notice through your Human Resources Department.
Complaints
If you believe your privacy rights have been violated or your Plan has not followed its legal
obligations under HIPAA, you may complain to the Plan and to the Secretary of Health and
Human Services. You won’t be retaliated against for filing a complaint. To file a complaint,
The Claremont Colleges’ Plan Administrator
c/o CUC Benefits Administration
101 S. Mills Avenue
Claremont, CA 91711
Contact
For more information on the Plan’s privacy policies or your rights under HIPAA, contact
The Claremont Colleges’ Plan Administrator
c/o CUC Benefits Administration
101 S. Mills Avenue
Claremont, CA 91711

INSCRIPCION ABIERTA 2015 4 de noviembre a 25

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