Medical, Prescription Drug, Dental, & Vision Benefits
Effective January 1, 2019, the health plan must be in compliance with the Affordable Care Act (ACA). A summary of ACA related changes are summarized below.
- Open Enrollment: An open enrollment will be added in 2019 for the 2020 plan year.
- Preventive Care: Preventive care items are included in the plan and are reflected in various areas of the plan document.
- Clinical Trial Participation: The plan will now pay Standard of Care expenses related to clinical trial participation.
- Additional definitions of terms used.
- Administrative Costs: That are solely for and/or applicable to administrative costs of completing claim forms and reports or for providing records wherever allowed by applicable law and/or regulations.
- Alternative Medicine: For holistic or homeopathic treatment, naturopathic services, and thermography, including drugs.
- Examinations Any health examination required by any law of a government to secure insurance or professional or other licenses, except as required under applicable federal law.
- Marijuana: For marijuana or marijuana-derived substances (like THC oil), even if the Participant has a prescription and marijuana is legal in the state where he or she lives.
- Improvement in coverage on contraceptives: All Food and Drug Administration (FDA)-approved contraceptives drugs, in accordance with the Health Resources and Services Administration (HRSA) guidelines.
- Smoking deterrents covered.
- Some over-the-counter (OTC) drugs are covered.
- A Claimant has the right to request a review of an Adverse Benefit Determination.
- Appeal Process: Additional opportunities to appeal decisions have been documented in the plan. Multiple appeals can be made in the following order:
- Through the Third-party Administrator (Consociate)
- Directly to the College
- An outside arbitrator
Health Insurance Portability and Accountability Act (HIPAA)
- The HIPAA section has been expanded to include both the privacy and security sections.
- Misuse of ID card will result in termination of coverage.
- Fraud is defined and will result in termination of coverage.
- Protection Against Creditors: Benefits can’t be tarnished, they can only be paid to a participant of the health care provider.
- Binding Arbitration: Applicable when all appeal processes have been exhausted and there is still a dispute.