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.