Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP, and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs.
If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage throught the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a "special enrollment" opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 1-866-444-EBSA (3272).
If you live in New York State, you may be eligible for assistance paying your employer health plan premiums. You should contact your State for further information on eligibility:
New York Medicaid
Website: http://www.nyhealth.gov/health_care/medicaid Phone: 1 800 541-2831
For more information on special enrollment rights, you can contact either:
U.S. Department of Labor
Employee Benefits Security Administration
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
1-877-267-2323, Menu option 4 Ext. 61565
OMB Control Number 1210-0137 (expires 12/31/2019)
WOMEN’S HEALTH and CANCER RIGHTS ACT
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
- All stages of reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and co-pays applicable to other medical and surgical benefits provided under the health insurance plans offered by the Diocese.
If you would like more information please contact your plan's customer service representative.