PWCS benefits comply with all federal mandates that govern public sector employee plans. To obtain more information about the requirements of these legislative acts, please refer to the following:

Health Insurance Portability & Accountability Act

HIPAA limits preexisting condition exclusions, permits special enrollment when certain life or work events occur, prohibits discrimination against employees and dependents based on their health status, and guarantees availability and renewability of health coverage to certain employees and individuals.

  • HIPAA Privacy Notice (PDF)
  • HIPAA Rights (PDF)
  • Authorization for Release of Protected Health Information Form (PDF)

COBRA

Employees and families who lose health insurance because they are no longer eligible for coverage under Prince William County Public Schools health insurance program may continue coverage by paying the full monthly premium plus 2%. Employees who lose coverage because of termination of employment (except for gross misconduct) or reduction in hours may continue an additional 18 months. Covered spouses and dependents may also continue coverage usually for an additional 36 months if they lost coverage for spouse/parent's death, divorce, or, when a covered child has reached the maximum age limit for coverage under the parent's policy. To continue coverage, the Prince William County Public Schools Benefits and Compensation Department must be contacted no later than 60 days from when coverage ceased.

Continuation Coverage Rights Under COBRA (PDF)

Rights for Women

The Women's Health and Cancer Rights Act of 1998 requires PWCS to notify you, as a participant or beneficiary of the PWCS Health Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for:

  • All stages of reconstruction of the breast on which the mastectomy is performed;
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
  • Prostheses and treatment of physical complication of the mastectomy, including lymphedema.

These benefits are subject to the plans' regular deductibles and co-payments. For more information, refer to the Summary Plan Documents (SPDs) for each of the medical plan providers, available on the PWCS Intranet or by contacting the Benefits and Compensation Department at benefits@pwcs.edu.

Lactation Support Program

In recognition of the well documented health advantages of breastfeeding for infants and mothers, and in conjunction with section 4207 of the Patient Protection and Affordable Care Act (also known as Health Care Reform), Prince William County Schools (PWCS) will provide a supportive environment to enable lactating employees "reasonable break times" and private, non-restroom locations, to express their milk during the work day for the first year of their child's birth. PWCS subscribes to the following worksite support approach. This approach shall be communicated to current employees in various locations and included in new employee orientation training.

Medicaid & CHIP Offer Free or Low-Cost Health Coverage to Children & Families

If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or Children's Health Insurance Programs (CHIP) to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in Virginia, you can contact the Virginia Medicaid and CHIP program offices to find out if premium assistance is available:

Medicare Prescription Drug (Medicare D) Plan

All PWCS medical plans include prescription drug coverage that is currently more comprehensive than the Medicare prescription drug plan. As an active employee, your PWCS medical coverage is primary to Medicare and you do not need to enroll in a Medicare Rx (Medicare D plan).

  • Creditable Coverage Disclosure to Part D Eligible Individuals

Social Security Reporting Requirement

Public Law 110-173 requires PWCS' health plans to report participants' Social Security Numbers (SSNs) in order to coordinate benefits with Medicare or other insurance benefits. All participants (employees and dependents) age 45 or older must provide SSNs in order for PWCS health plans to meet the requirements of this law. All participants who are receiving kidney dialysis or have received a kidney transplant, as well as all participants under age 45 who have Medicare, are also required to report SSNs. For more details on this legislation, you may go to www.cms.hhs.gov/MandatoryInsRep.

Disclosure of Grandfather Status

Prince William County Public Schools believes its health insurance plans are considered "grandfathered health plans" under the Patient Protection and Affordable Care Act (PPACA). As permitted by the Act, grandfathered health plans can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your Anthem PPO plans, and Healthkeepers HMO/POS plan, may not include certain consumer protections of the PPACA that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Act, for example, the elimination of lifetime limits on essential benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health status can be directed to the plan administrator at 703-791-8568.

Patient Protection Notice

The Anthem Healthkeepers HMO/POS plan requires the designation of a primary care provider. You have the right to designate any primary care provider who participates in the plan network and who is available to accept you or your family members. Until you make this designation, the plan may designate one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact Anthem Healthkeepers at 1-844-404-2123.

For children, you may designate a pediatrician as the primary care provider.

You do not need prior authorization from Healthkeepers or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the plan's network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact Anthem Healthkeepers at the number above.

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