Open Enrollment

• Health plan Health Insurance Portability and Accountability Act (HIPAA) privacy notice (PDF)
• Marketplace coverage options notice (PDF)
• Medicaid and Children’s Health Insurance Program premium assistance notice (PDF)
• Cigna medical waivers notice (PDF)
• Surest medical waivers notice (PDF)
• Non-discrimination notice (PDF)
• Medicare Part D notice of creditable coverage (PDF)
• Notice of Affordable Care Act mandate to collect dependent Social Security numbers of covered individuals (PDF)
• Women's Health and Cancer Rights Act notice (PDF)
• Notice of your rights and protections against surprise medical bills (PDF)

Cigna Standard, Cigna Premium and Surest Medical Plans

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Novant Health and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Novant Health has determined that the prescription drug coverage offered by the Novant Health Group Benefits Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When can you join a Medicare drug plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two-month special enrollment period (SEP) to join a Medicare drug plan.

What happens to your current coverage if you decide to join a Medicare drug plan?

If you decide to join a Medicare drug plan, your current Novant Health coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current Novant Health coverage, be aware that you and your dependents may not be able to get this coverage back.

When will you pay a higher premium (penalty) to join a Medicare drug plan?

You should also know that if you drop or lose your current coverage with Novant Health and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For more information about this notice or your current prescription drug coverage

Contact the Novant Health People and Culture Service Center at 800-890-5420 or 910-667-6000 if you work for New Hanover Regional Medical Center.

You will get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Novant Health changes. You also may request a copy of this notice at any time.

For More Information about Your Options under Medicare Prescription Drug Coverage

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare if you request it, and the handbook is available online at medicare.gov. You may also be contacted directly by Medicare drug plans.

Call:

• Your state health insurance assistance program (for personalized help) or
• 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web or call them at 800-772-1213 (TTY 800-325-0778).

Date: October 15, 2023
Name of Entity/Sender: Novant Health Benefits and Culture

Section 6055 of the Affordable Care Act, also known as healthcare reform, requires health coverage providers, i.e., Novant Health, to collect the Social Security number of each person enrolled in our medical plan — and that includes your covered dependents. We need to report this information to the Internal Revenue Service (IRS) in order to comply with healthcare reform rules.

What is the purpose of requesting dependent Social Security numbers?

The requirement for health coverage providers to report to the IRS the Social Security number of each person enrolled in our medical plan is necessary for the IRS to verify an individual’s coverage without the need to contact the individual.

How do I provide my dependent’s Social Security number?

Open enrollment is an excellent time to review whether you have provided the Social Security number for all of your covered dependents. If you have previously enrolled a family member, such as a young child, and you did not provide the Social Security number at that time, please provide it during open enrollment.

What if my dependent does not have a Social Security number?

If one of your dependents does not yet have a Social Security number, simply go to the Social Security Administration website and apply. Applying for a Social Security card is free.

How can I get more information?

For more information about Section 6055 of the Affordable Care Act and the requirement for health coverage providers to collect the Social Security number of each person enrolled in our health plan, please visit the IRS website and enter "Section 6055" in the search field or contact the Novant Health Human Resources Service Center at 800-890-5420.

Do you know that the Novant Health medical plans provide benefits for mastectomy-related services as a result of cancer treatment that includes all stages of reconstruction? Benefits include the following services:

• Reconstructive surgery on the breast on which the mastectomy is performed
• Treatment on the other breast to produce a symmetrical appearance following a mastectomy
• Prostheses
• Treatment for physical complications for all stages of mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes)

The manner of coverage will be determined by the plan in consultation with the patient and the attending physician. Coverage will be paid according to normal provisions of the plan. These provisions apply to mastectomies received while either you or your dependent is covered under the Novant Health plan.

If you have any questions about your benefits for treatment of breast cancer, please contact your insurance provider:

• Cigna: 800-244-6224
• Surest: 866-683-6440

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is "balance billing" (sometimes called "surprise billing")?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care — like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You're protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist or intensivist services. These providers can’t balance-bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance-bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have these protections

• You’re only responsible for paying your share of the cost (like the copayments, coinsurance and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
• Generally, your health plan must:
  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”)
  • Cover emergency services by out-of-network providers
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit

If you think you've been wrongfully billed

Contact the U.S. Department of Health & Human Services at 877-696-6775 or the North Carolina Department of Insurance at 855-408-1212. Or the federal phone number for information and complaints is 800-985-3059.

More information

For more information about your rights under federal law visit the:

• U.S. Department of Health & Human Services website
• Centers for Medicare & Medicaid Services website