If you have Medicare or will become eligible for Medicare in the next 12 months, a 2006 Federal law gives you more choices about your prescription drug coverage. The Company has determined that the prescription drug coverage offered to its associates is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage. A full copy of the Medicare Part D Notice is included with your enrollment materials. For additional copies, please contact your HR Representative.
Group health plans and health insurance issuers generally may not, under federal law restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother of her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours if applicable).
HIPAA requires that you be informed of your Special Enrollment rights when you and/or your eligible dependents decline health care coverage during the initial enrollment period. If you are declining coverage for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself and/or your dependents in the medical plan provided that you request coverage after your other coverage ends within the specified time frame. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption or a court order, you may be able to enroll yourself and/or your dependents, provided that you request enrollment within 31 days after the marriage, birth, adoption or placement for adoption or the court order.
If you are declining health coverage for yourself or your dependents (including your spouse) and you are not currently covered under a medical plan, you will be considered a late applicant. HIPAA allows a late applicant to enter a medical plan only during an open enrollment period.
This law requires group health plans that provide coverage for mastectomies to also cover reconstructive surgery and prostheses following mastectomies. The law mandates that a plan participant receiving benefits for a medically necessary mastectomy who elects breast reconstruction after the mastectomy, will also receive coverage for reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses, treatment of physical complications of all stages of mastectomy, including lymphedemas. This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions that apply for the mastectomy.
The full reward (the non-smoker rate) must be available to individuals who qualify by satisfying a reasonable alternative standard. Plans have flexibility to determine how to provide the portion of the reward corresponding to the period before an alternative was satisfied (e.g., payment for the retroactive period or pro-rata over the remainder of the year) as long as the method is reasonable and the individual receives the full amount of the reward. In some circumstances, an individual may not satisfy the reasonable alternative standard until the end of the year. In such circumstances, the plan or issuer may provide a retroactive payment of the reward for that year within a reasonable time after the end of the year, but may not provide pro-rata payments over the following year (a year after the year to which the reward corresponds).
The Mental Health Parity and Addiction Act of 2008 generally requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays and deductibles) and treatment limitations (such as annual visit limits) applicable to mental health or substance use disorder benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. For more Information regarding the criteria for medical necessity determinations made under your employer’s plan with respect to mental health or substance use disorder benefits, please contact your plan administrator at 718-316-4524.
Michelle’s Law protects a full-time, student-age dependent from losing medical coverage under the Benefits Plan if he/she is (1) a dependent child of a participant or beneficiary under the terms of the plan; and (2) enrolled in a plan on the basis of being a student at a postsecondary educational institution immediately before the first day of a medically necessary leave of absence from school. A dependent covered under the law is entitled to the same benefits as if the dependent continued to be enrolled as a full-time student. The law also recognizes that changes in coverage (whether due to plan design or a subsequent open enrollment election) pass through to the dependent for the remainder of the medically necessary leave of absence. Michelle’s Law requires that the plan treat such a dependent as a full-time student for one year after the first day of the medically necessary leave of absence or until the date on which such coverage would otherwise terminate under the terms of the plan, whichever occurs first.
Eligible plan participants may be eligible to receive assistance in paying their contributions for health coverage under a State Children’s Health Insurance Program (SCHIP). This program is jointly financed by the federal and state government and is administered by the states. Each state determines the design of its program, eligibility criteria, benefit packages, payment levels and plan administration. If you are eligible for this benefit, you will be required to pay the full cost of the health coverage for your child and then you will be reimbursed by the state for the cost of your child’s coverage. For more information please visit www.insurekidsnow.gov or call toll-free 1-877-KIDS-NOW.
NOTE: Changes in eligibility for Medicaid, CHIP or premium assistance under these programs are considered Qualifying Life Events. Refer to page 3 of this Benefits Guide for further details.
The Family and Medical Leave Act (FMLA) allows up to 12 weeks of unpaid, job protected leave for specific family emergencies such as serious illness or the birth or adoption of a child. FMLA eligible associates are eligible for up to 26 weeks of FMLA leave in a 12-month period for the care of a service member who is injured in the line of duty. This leave is only available to the service member’s spouse, son, daughter, parent, or next of kin. “Next of kin” is defined as the nearest blood relative of the service member. You are eligible for FMLA leave when you work at a location with 50 or more associates within a 75 mile radius, have been employed with the Company for at least 12 months and have worked a minimum of 1,250 hours in the prior 12-month period. Associates are eligible for FMLA if they meet the criteria listed above.
Under NYC’s Earned Safe and Sick Time Act, employees working in NYC for more than 80 hours a year can earn up to 40 hours of safe and sick leave each year. Eligible employees have a right to safe leave, which can be used to seek assistance or take other safety measures if an employee or a family member may be the victim of any act or threat of domestic violence or unwanted sexual contact, stalking, or human trafficking. Eligible employees have the right to sick leave, which can be used for the care and treatment of yourself or a family member. Eligible employees have the right to be free from retaliation from your employer for using safe and sick leave. Eligible employees, have the right to file a safe and sick leave complaint by email, mail, telephone, or in-person. For more information, including Frequently Asked Questions, go to nyc.gov/PaidSickLeave or call 311 and ask for information about Paid Safe and Sick Leave.
The Uniformed and Services Employment and Re-Employment rights Act of 1994 (USERRA) sets requirements for continuation of health coverage and re-employment in regard to an Employee’s military leave of absence. These requirements apply to medical and dental coverage for you and your Dependents. They do not apply to any Life, Short Term or Long Term Disability or Accidental Death & Dismemberment coverage you may have. A full explanation of USERRA and your rights is beyond the scope of this document. If you want to know more, please see the Summary Plan Description (SPD) for any of our group insurance coverage or go to this site: http://www.dol.gov/vets/programs/userra/main.htm.
An alternative source is VETS. You can contact them at 1-866-4-USA-DOL or visit this site: http;//www.dol.gov/vets. An interactive online USERRA Advisor can be viewed at http://www.dol.gov/elaws/userra.htm.
IMPORTANT: This is a fixed indemnity policy, NOT health insurance.
This fixed indemnity policy may pay you a limited dollar amount if you’re sick or hospitalized. You’re still responsible for paying the cost of your care.
Looking for comprehensive health insurance?
Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options. To find out if you can get health insurance through your job, or a family member’s job, contact the employer.
Questions about this policy?
For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners’ website (naic.org) under “Insurance Departments.”
Legal Notice
The general information contained in this summary does not address all requirements of the Plans and complete information is contained in the office Plan documents. If this summary differs from the terms and provisions of the official Plan documents, the official Plan documents will govern and control. The applicable Plan documents govern the determination of your benefit, and no communication, oral or written, shall alter your benefit. Standard Motor Products reserves the right to amend, suspend or terminate its Plans at any time, in whole or in part. Participation in these Plans is not an offer or guarantee of employment. Review these Required Notices for information about your rights and protections, privacy, and more.